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

asked 2 years ago by Wuz in Missouri
Latest answer by Tom J. Pousti, MD
Question viewed 1,521 times
Tags: age 17 or under, asymmetry, DDD cup, insurance

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?

19 answers to Will Insurance Cover Asymmetrical Breasts for 16-year-old?

See a Board Certified Plastic Surgeon

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

marinaplasticsurgery.com

Breast Reduction for 16-year-old?

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... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Insurance coverage for correction of breast asymmetry

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... more

Armando Soto, MD
Orlando Plastic Surgeon

www.DrArmandoSoto.com

Breast Assymetry in 16 year old

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... more

Clayton L. Moliver, MD
Houston Plastic Surgeon

www.drmoliver.com

Insurance and breast asymmetry

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

Insurance Coverage for Asymmetric Breasts

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

Breast Asymmetry and Insurance Coverage

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... more

Michelle Copeland, MD, DMD
New York Plastic Surgeon

Options for asymmetrical breasts

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... more

Richard Baxter, MD
Seattle Plastic Surgeon

Asymmetric breasts

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

Breast Reduction Surgery

They would absolutely not cover any surgery to do with the right side. There is a small possibility they may cover a breast reduction surgery on the left side. This entriely depends on your height and weight. The BSA, body surface area is plugged into a table and there is a predetermined amount of breast tissue to be removed. Hope that helps.

Farbod Esmailian, MD
Orange County Plastic Surgeon

Congenital breast asymmetry and options for treatment: Will Insurance cover the surgery

Clearly you have an obvious breast asymmetry. Your main problem, in obtaining insurance coverage, is convincing your carrier that this is a functional and not a cosmetic problem. In my experience, they rarely cover these procedures. If you are looking to limit your costs, you may want to consider doing liposuction on your left breast which will limit your costs and scars. While it will not completely correct the asymmetry, it may be the simplest method to achieve long term relief and... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Insurance and breast surgery

It is very difficult to say whether or not an insurance company will cover a breast reduction procedure. Many insurance companies have put up very high hurdles for patients to jump over to accomplish this goal and many times the patients can not get approval.

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance coverage for breast lift or breast reduction.

Insurance Coverage for Breast Reduction or Breast Lift: Answer by George J. Beraka, MDManhattan Plastic Surgeon80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points. 1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches. 2) Very big reductions (like from an F cup to a C cup) will... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast Asymmetry correction - Insurance Coverage

The great majority of Americans do not understand how medical insurance operates nor are they willing to invest the time to understand its purposeful complexity. Insurance companies, like all businesses, are not charitable organizations. They are in business to make money for their investors and stockholders. Under our present and soon to much worsen health care system, insurance companies petition and after going through multiple state-specific hoops (IE legal fees and payoffs to many... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Insurance Coverage of Asymmetrical Breasts

Coverage of breast asymmetry varies a lot among insurance cos. and is related to the degree of asymmetry as well as the proposed way of correction and the presence of symptoms. In your case the reduction of the larger breast might be covered if you were willing to accept a C or small D cup.

John Whitt, MD
Louisville Plastic Surgeon

Insurance cover asymmetrical breasts for 16-year-old

Great question. There are many variables in obtaining insurance coverage for congenital breast asymmetry. What type of health insurance do you have? If medicaid or HMO most likely there is no coverage. If you have a PPO, HCA types than there is a possibility. You must have your PS write a detailed letter of predetermination of benefits. Include photos and any other medical history. MAYBE you will get an acceptance of coverage letter. But do not hold your breath, it happens very rarely. In... more

Darryl J. Blinski, MD
Miami Plastic Surgeon

Insurance coverage for breast reduction

You may be able to obtain insurance coverage for breast reduction on the larger side. A few points to consider: 1. Insurance companies have two major criteria for determining coverage: symptoms related to enlarged breasts (shoulder pain, back pain, neck pain, slumping posture, etc.) and amount of tissue to be removed (generally 400 to 500 grams minimum per side). 2. Although you... more

Ronald Friedman, MD
Dallas Plastic Surgeon

Insurance coverage for breast asymmetry

Unfortunately, while you have a very distinct asymmetry, I have never had a patient like you get covered by insurance in 20 years of breast surgery. The insurance companies differentiate between procedures they think are "functional" or "medically necessary" as being those they should cover because you can't live normally without them. They classify all else as "cosmetic" and not worthy of coverage. Unfortunately, they would put your case in the second group.... more

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Cosmetic breast surgery and insurance

There is no question that you have breast asymmetry and plastic surgeons are sensitive to the fact this makes it difficult for clothing, exercise, etc. Unfortunately many insurance companies do not see things the same way. You are young and it is probable that your breasts will continue to change as you mature more. This does not mean that the right breast will catch up and to achieve close to symmetry will require a surgery of one kind or another. Your best approach is to check with your... more