I am 21 years old and 5'1, weigh 145lbs, I have 36G breast, which are starting to not fit into my 36G bras, do you think it would be a good idea for me to get a reduction? Would I be able to get some help from my insurance company? I used to be a runner, but since my breast kept growing each year it has become more and more difficult to workout in the least bit. What is the likelihood that a reduction would benefit me? Would it lessen my back pain? Are there any great surgeons in AL?
I Am 21 Years Old and 5'1, Weigh 145lbs, I Have 36G Breast, Which Are Starting to Not Fit into my 36G Bras. Reduction Candidate?
Doctor Answers (9)
Great candidate for breast reduction
Based on your measurements you seem to need a breast reduction. The procedure would really be very beneficial to you. BUT I would definitely meet with a plastic surgeon and look at before and after to determine if you will be okay with the incisions. There are many issues to resolve and it is best done with you and your plastic surgeon.
Breast Reduction: Am I a candidate for surgery? Relief of Symptoms!
Breast Reduction surgery is one of the highest satisfaction surgeries that are performed. Women often have significant symptoms as a result of very large breasts (macromastia). Common complaints are neck and back pain, shoulder pain and grooving, chronic moisture and rash of the skin folds of the breast, and difficulty with activity. If these problems are documented, and photographs and clinical evaluation are submitted to insurance companies, they will often cover this procedure. Through specific incisions, skin design, and breast gland and fat removal, a board certified plastic surgeon can create beautiful, aesthetic, symmetric breasts and eliminate the excessive weight and accompanied symptoms. Often, patients wake up from surgery with immediate relief of those symptoms. A detailed consultation will determine if you are a candidate and if you can benefit from this procedure.
Women with heavy, pendulous breasts can suﬀer from a skeletal imbalance that contributes to back, neck, and shoulder pain. Some experience numbness in their hands and breathing problems due to nerve compression as their breasts pull down on their shoulders. Many women actually have grooves cut in their shoulders by their bra straps. They can develop a rash under their breasts, especially during warm weather. Psychologically, many patients have felt self-conscious about their breasts since they were young. “All my life I’d avoided any attention being drawn toward my breasts,” one patient said. Women having breast reductions usually are DD-cups or larger. The goal of the procedure is to relieve symptoms.
You have a lot going for you because you have a low weight. Insurance may cover breast reduction for some women. It depends on the patient’s breast size, body type, and symptoms. Most insurance companies have a formula based on your height, your weight, and how much your surgeon estimates will be removed. Usually removal of about a pound from each breast is required for insurance coverage.
Health care providers are mercenary about denying coverage for breast reduction. They don’t care if your clothes don’t ﬁt or you can’t exercise. In my experience, they don’t even care about your pain and discomfort, much less psychological embarrassment. It all boils down to your height and weight versus how much breast tissue will be removed. You can’t necessarily pick your desired breast size or shape. To remove less than the insurance company’s formula requires places the procedure in the realm of cosmetic surgery. That means you pay the bill.
Your surgeon should get a detailed medical history because some health-care providers demand a history of treatment for back pain to authorize coverage. I measure the breasts and often take photographs to be mailed with the insurance letter. If I don’t comply with the rules, the insurance provider—who holds all the cards—may not authorize paying for the procedure.
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Yes, insurance companies can cover breast reduction
Yes, from what you describe you may be a candidate for breast reduction. Insurance may pay for it if you meet their criteria. See a plastic surgeon in your area for an evaluation and measurements. A precertification and predetermination can be done before the breast reduction to ensure that your insurance company is going to cover the procedure. Best of luck.
You sound like a great candidate for breast reduction.
Hi. I wrote this article about a year ago. I hope it is helpful.
80% 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 usually be covered.
3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.
4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.
5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.
6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.
7) Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.
8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.
9) Don't give up. If the first request is denied, demand an appeal.
10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.
It is really your choice to have a breast reduction. If you have symptomatic macromastia (i.e. back and ndeck pain) you may very well be a candidate.
It sounds as if you would be a great candidate
Women who have breast that are out of proportion to their body size are usually good candidates for breast reduction surgery. Given your young age you do need to be aware that you may not be able to breast feed after the procedure. With the size of your breasts this would probably be a good trade off.
Good luck with the procedure,
Breast Reduction Candidate?
Thank you for the question and congratulations on your decision to look into breast reduction surgery. It is one of the most patient pleasing operations we perform.
Based on your description you may be a good candidate for breast reduction surgery; for physical and emotional reasons. 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.
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 understand that further surgery may be necessary in the future (for example if the breasts were to grow in size again).
In regards to finding a “great surgeon” in your area, check with the American Board of Plastic Surgeons and/or and the American Society of Plastic Surgeons for appropriate training and credentials. Then, make sure you see lots of examples of the surgeons work in pictures ( better yet meet with patients who have had similar procedures).
Breast Reduction Candidate
You should be able to be considered for a breast reduction if you meet certain criteria. Call a Board Certified plastic surgeon or get a referral from your primary care doctor.
You may want to ask the surgeon's office ahead of time if there is anything else they would like you to bring (insurance information, name of primary care physician). For breast reduction surgery, it would be good to find out what criteria your insurance company requires to approve the surgery and have it available at the time of consultation. This includes:
Symptoms such as neck, back, shoulder pain, headaches, hand numbness, breast pain, rashes under the breasts, poor posture.
Documentation from your primary care doctor of these symptoms
Documentation that you tried 6 months of physical therapy to improve these symptoms
Other requirements based on your insurance company's protocol
Results of your last mammogram or other breast studies (if you had any)
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.
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