Will Insurance Cover Asymmetrical Breasts for 16-year-old?

Hi, I'm 16 and my right breast is at a DDD while my left is a C. I constantly am in pain on my right side and my shoulders and back are seemingly getting crooked (in my opinion.) It's really hard for me to go out like this or even see myself in the mirror. I know that this is how I would go about the surgery: - reduction in right breast - double implants (to a D or DD) - and areola reduction on my right and possibly left. will any of this be covered by Insurance?

Doctor Answers (20)

Insurance coverage for breast reduction

+1

Breast reduction may be covered by insurance if you meet certain critera, specified by your insurance coverage.  Often times, insurance company will need documentation of back pain, shoulder pain, photos, your height and weight, size of your breasts and proposed weight of breast tissue that would be removed.  If you do not meet the criteria set by your insurance coverage, you will need to undergo breast reduction by self-pay.  Your self-pay breast reduction cost will differ depending on your surgeon's fee, facility fee, and anesthesia fee.  There is a geographic difference as well.  It will vary from $8000-$10,000.  Please visit with board-certified plastic surgeons to discuss the overall cost as well as potential risks, alternatives, and benefits.  Good luck to you.


Houston Plastic Surgeon
4.5 out of 5 stars 36 reviews

Breast Reduction for 16-year-old?

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Thank you for the question.
It sounds like  you are dealing with juvenile breast hypertrophy; in other words, the breasts are too large for the frame causing  both physical and psychological distress.

As  you think  about  breast reduction surgery make sure you do your homework and understand the potential risks and complications associated with  the procedure.  Unsatisfactory scarring is  one of the potential complications. Make sure you also understands that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

On the other hand, breast reduction surgery is one of the most patient pleasing operations we perform and I think that for the right teenager (enough symptoms) it may be an excellent option (regardless of the age).
Sometimes breast  reduction surgery is covered through health insurance. The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.
Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.


I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 701 reviews

See a Board Certified Plastic Surgeon

+1

You should have insurance coverage for your breast reduction.   See a qualified, Board Certified plastic surgeon with your parents and have them take photos and send a letter to your insurance company.  I would think that you would be covered for a breast reduction.  Good Luck!   Dr Grant Stevens   

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 66 reviews

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Insurance coverage for correction of breast asymmetry

+1

Hi there-

Unfortunately, it has been my experience that cases like yours are almost NEVER covered by insurance plans.

Unless you can prove that your breasts are the cause of FUNCTIONAL problems (this would require multiple visits to physical therapists, chiropractors, and possible spine surgeons willing to say you have problems due to your breasts), I would not be optimistic.

Your breasts can be made beautiful and comfortable, but I would not want to hold out false hope to you that your insurance company will want to help you with this.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
5.0 out of 5 stars 98 reviews

Breast Assymetry in 16 year old

+1

What a great question! Here are some thoughts:

1. Ins cos. are a bother to deal with. Often don't pay. Will want a certain volume removed. Won't pay for any technique that is advanced or not on their list.

2. Without an exam it is hard to say for sure, but some younger women are candidates for liposuction alone for the larger breast. This avoids the scars that will likely be hypertrophic for a while in a 16 yr old (high growth hormone levels I believe is the cause). See my blog with pics of this. www.drmoliver.com/blog

3. If you try to go ins route the cost will likely be much higher for the implant part of the case. Besides I would do the reduction first and let it completely heal - 3 months before considering further surgery. The idea is to really try to get the larger breast to match the smaller breast before proceeding. You never really know where that operated breast is going to wind up - volume and firmness especially - until all has healed. Also, placing an implant at the same time as a reduction can be risky.

Clayton L. Moliver, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 11 reviews

Insurance and breast asymmetry

+1

It is clear that you have a problem, and the large right breast may be contributing to your back pain. However, one cannot predict what your insurance company will cover. I suggest that you have a plastic surgery consultation and ask the plastic surgeon to write a letter on your behalf. Also, submit any documentation you have if you have had treatments for back pain. Good luck.

Bruce Genter, MD
Abington Plastic Surgeon
4.0 out of 5 stars 11 reviews

Insurance Coverage for Asymmetric Breasts

+1

Whether or not insurance covers a particular surgery or diagnosis is really up to the insurance company.  I would recommend contacting your insurance company and carefully reviewing your individual policy.  Good luck. 

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 55 reviews

Breast Asymmetry and Insurance Coverage

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Congenital breast deformities and severe breast asymmetry as well as Breast reduction for large breasts is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine.

Recently, managed care has adopted stricter standards for coverage, so these problems have to be thoroughly documented in writing by your primary care physician and plastic surgeon. They may also have to submit photographs. Even then, you may be required to seek a second opinion from a chiropractor, physical therapist, or orthopedic surgeon.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.5 out of 5 stars 8 reviews

Options for asymmetrical breasts

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Most likely the pain on your right side is actually from the weight of the left breast pulling and putting strain on the muscles. So reducing the left side does make sense and insurance might cover that. There is another option that might work out, which is a grant program from the research foundation of the American Society for Aesthetic Plastic Surgery. You would need to see an ASAPS member surgeon for that, to see if you qualify. The link below should give you some more information, and the ASAPS website is www.surgery.org.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 23 reviews

Asymmetric breasts

+1

Unfortunately, it would be rare for an insurance carrier to cover anything on your right breast. They may cover a reduction of the left side, but anything having to do with implants they are very wary of unless it is for breast cancer.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.