Age 50, 38J. Am I a Candidate for Breast Reduction (Covered by Insurance)?

I Am a 50 Yr Old Female with 38 J Breasts. Tying to Find a Bra That Size  Very Expensive and hard to find. my back and neck hurt constantly and i have a hard time exercising. i do walk and am eating healthy. my weight is 180 and i'm 5'2.do you think i am a good candidate for a reduction? will insurance pay for a reduction with out having to go too physical therapy?

Doctor Answers (8)

Breast Reduction through Insurance

+1

Thank you for the question. 

Breast reduction surgery is one of the most patient pleasing operations we perform. It sounds like, based on your description, that you may be  an excellent candidate for the procedure. Each insurance company differs with their criteria to authorize the surgery. I send a letter to the insurance company with the patient's photos for authorization.

I would suggest  in person consultation with a well experienced board-certified  plastic surgeon. Ask  to see many examples of his/her work in pictures or ( better yet) in person.

Best wishes.


San Diego Plastic Surgeon
5.0 out of 5 stars 759 reviews

Insurance and Breast Reduction Surgery

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Insurance coverage of breast reduction surgery has become more difficult to obtain in recent years.  

The requirements include symptoms such neck and back pain that have not responded to physical therapy, and an anticipated minimum weight of breast tissue being removed which varies from company to company.

Your breasts are large enough that the weight requirement should be met and ultimately your breast reduction should be covered by your insurance company.

Fredrick A. Valauri, MD
New York Plastic Surgeon

38 J Breasts

+1

If your size is truly a 38 J, then you could benefit greatly from a breast reduction procedure.  An insurance pre-authorization letter will need to be submitted by your PS to determine insurance coverage.  My breast reduction patients are among the happiest patients I treat and they all say the same thing, "i wish I had done this earlier' Don't delay, comfort is waiting for you after your procedure!!

David Finkle, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 46 reviews

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Breast Reduction Helps to Relieve Symptoms/Often Covered by Insurance

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Large breasts such as yours (38J) can cause many symptoms, including those you have described.  Breast reduction surgery significantly helps to reduce those symptoms that are caused by large breasts. As a generality, my breast reduction patients are among my happiest because not only are their symptoms improved (or relieved entirely), but their breasts typically look better, too.  Furthermore, activity levels are increased, and many of my patients that couldn't loose weight before, go on to loose weight afterwards.  Your height/weight ratio indicates you would get a more "boxy" result, but still acceptable. And assuming you are in good health, there isn't really an age criteria. 

Regarding insurance coverage....physicians are often frustrated when it comes to breast reduction.  It seems like companies each have their own rules.  Typically your plastic surgeon would take a thorough history and exam, assess if you are indeed, a good candidate, then write a letter for prior approval. Supporting information is always helpful but not usually mandated, such as a letter of need from your PCP, a physical therapist, or an orthopedic surgeon if you have been under the care of someone for your symptoms.   Some companies will not give prior approval, but state in their cover letter "it is a covered service" but will not be able to determine what is covered until the claim is sent in.

The best option is to consult with your plastic surgeon; he/she will inform you of your options and will also assist in filing the necessary paperwork to check into your coverage.  Based on the companies response, your surgeon will direct you accordingly, e.g., schedule as a "cosmetic surgery" to get the lowest fees, or arrange for financing through Care Credit, etc.  Remember, the "squeaky wheel gets the grease"....so be sure to be an integral part of the paperwork so the process doesn't take months. (Get a contact name at your insurance carrier so paperwork can be sent certified to a "real" person, otherwise they often report they never received the request!) Good Luck!

 

Jana K. Rasmussen, MD
West Palm Beach Plastic Surgeon

Breast Reduction and Insurance

+1

You should definitely qualify for a breast reduction, however it depends on what your insurance policy states, insurance companies can vary greatly on this, and some state that they do not cover breast reduction at all. For those that do, they have different requirements. Some want documentation from different sources documenting the  different things that you have tried to alleviate your symptoms, such as physical therapy, special bras, pain relievers, etc. and some only require that the surgeon state how many grams of breast tissue is to be removed. It usually is not too hard to get approval and your board certified surgeons office should be able to help you. This is a wonderful procedure with very high patient satisfaction. Good luck!

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 30 reviews

Breast reduction and insurance coverage

+1

If your breasts are a J cup the breast reduction surgery would probably be covered by your health insurance  company.  Your doctor will need to examine you first and probably will need to submit your photos to the company. 

Vincent D. Lepore, MD
San Jose Plastic Surgeon
5.0 out of 5 stars 17 reviews

Breast reduction covered by insurance

+1

Based on your symptoms and body structure, you would likely be a candidate for a breast reduction.  I would consult with a board certified plastic surgeon to be examined and to review your current health insurance. Photos will need to be submitted to the insurance company before they will approve the surgery. It sounds like you have enough breast tissue to qualify for this procedure.

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 150 reviews

Breast reduction candidate

+1

I think you are a good candidate for breast reduction based on your bra size and your physical symptoms.  Breast reduction is a great operation for relieving pain in the upper back, shoulders, and neck in women with large breasts.  I would guess that your insurance company will cover it, but you would need an examination by a surgeon.  He will submit an estimated weight of reduction to your insurance company.  You will likely also need corresponding information from your primary physician documenting your symptoms.  

This is an operation I love to perform.  Nearly everyone feels better after wards.

Good Luck.

Gordon Lewis, MD
Richmond Plastic Surgeon
5.0 out of 5 stars 8 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.