At 5'1" and 119lbs with 32GG Breasts am I a candidate for breast reduction through Blue Cross/Horizon/Medicade? My PCP says I am but must find a surgeon. I am 19 years old.
I Am 5'1", Weigh 118lbs and Have 32GG Breasts. Am I a Candidate for a Reduction?
Doctor Answers (14)
Breast Reduction Candidates and Where to find a Qualified Surgeon
Yes, you sound like you would be a good candidate for Breast Reduction.Here are some generalizations as to who are good candidates:
Candidates for Breast Reduction surgery are women who wish to have smaller breasts to achieve a more proportional appearance or to alleviate physical discomfort. Breast reduction can correct symptoms from excessively large, heavy breasts that may cause the inability to do certain exercises, or create back, shoulder and neck pain, poor posture, bra-strap shoulder indentations and chafing or rashes under the breasts. Women experiencing these discomforts may benefit from Breast Reduction, also called Reduction Mammoplasty. Furthermore, large breasts may interfere with normal daily activities or exercise and will be more comfortable when reduced. Women who feel that their excessive breast size decreases a sense of attractiveness and self confidence, or results in unwanted attention are also candidates.
To find a Board Certified plastic surgeon, check out the American Society of Plastic Surgeons web site on the below link.
Sounds like you are a great candidate for a breast reduction
From your description, it sounds like you are a great candidate for a breast reduction predominantly with stadard techniques.
Breast Reduction in Teens
Yes, you are a very obvious candidate and your family doctor is correct. Find a surgeon who you understands your concerns and addresses your questions to your satisfaction. Your family doctor will assist your plastic surgeon with a letter to your insurance company to support you.
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TO find out if your insurance company will "cover" your surgery, you should contact them and find out what their authorization policy is for this procedure. It sounds like you should be covered.
You are a candidate for breast reduction but insurance sponsorship isn't assured.
Breast reduction would address any musculoskeletal strain and skin rashes you may experience, as well as provide a better proportioned frame. Irregardless of the health care reform move, insurance has evolved to paying for the minimum services for health care. Surgeries which are considered reconstructive but have cosmetic advantages are carefully scrutinized for eligibility requirements and are generally low priority for payment. The other consultants are correct in advising you to ask your PCP for recommendations for PS who are providers for your insurance and have interest in breast reduction. The ASPS website is also a good source for referrals.
In the U.K. the NHS (National Health Service) has practically phased out insurance coverage for breast reductions. As a consequence many Brits who are determined to have relief, resort to paying for the procedures themselves. As the inclusion criteria become more stringent, many Americans will either opt out or self insure. Most PS offer financing, so your surgery may be more feasible than you think. good luck.
Breast reduction and insurance
It sounds like you would benefit from a breast reduction in terms of body image and future back and shoulder problems. Breast reduction patients are some of my happiest patients. They feel better physically and psychologically. Getting an insurance company to pay for a breast reduction is quite another proposition. The process can take up to a year and I am not optimistic that the outcome will be positive. Many of my patients pay for their surgery out of pocket.
Tal Raine MD
Candidate for Surgery does NOT mean YOUR Insurance will pay for it
Regarding: "5'1" and 119lbs with 32GG Breasts am I a candidate for breast reduction through Blue Cross/Horizon/Medicade? My PCP says I am but must find a surgeon. "
There is NO doubt that you have overly large breasts which are probably associated with shoulder, neck and or chest pain. MANY insurance companies would agree that patients such as yourself should be allowed to go ahead and have a breast Reduction.
BUT - being a good candidate surgically speaking does not mean that YOUR insurance company will agree. Every insurance policy is different. If your policy does not include "Breast Reduction Benefits" it would NOT make a difference what size your breasts were - they would NOT pay for your surgery.
I am not familiar with your policy but as a rule Medicaid is a Federally sponsored health plan for people earning below a certain amount of money. They hardly pay for anything remotely associated with Plastic Surgery and when they do reimburse plastic surgeons, they reimburse very poorly. Unlike primary Care doctors who can shorten their visits from 15 minutes to 10 minutes and go from seeing 25 to 40 patients a day, surgeons cannot do more operations to make up for poor payments. As a result, very few Plastic surgeons can afford to work with medicaid.
Ask your PCP which Plastic surgeons he works with who DO accept Medicaid and go see them.
Heavy breasts with symptoms are candidates for breast reduction
From your description, your breasts are very large in proportion to your body's frame. If you are having symptoms attributable to your large breasts, such as neck and back pain, and these symptoms cannot be corrected by other means, such as wearing a bra, physical therapy, etc. you are a candidate for a breast reduction. It can be difficult to get approval from the insurance companies for the surgery; however, many plastic surgeons offices will help you through the process of obtaining insurance approval. You should contact your insurance company and find out who is an approved plastic surgeon; they should have a list. You can then make an appointment with one or more of these doctors for a consultation. If this does not work, many university teaching programs that train plastic surgeons have clinics. The cost is usually fairly low; a plastic surgery resident or fellow would perform the surgery under the supervision of an attending plastic surgeon who is fully trained. Check with the University of Medicine and Dentistry of New Jersey in Newark; you could also come in to NYC. Check with Institute of Reconstructive Plastic Surgery-NYU, Manhattan Eye Ear and Throat Hospital, Lenox Hill Hospital, New York Presbyterian Hospital, Bellevue Hospital-they all have plastic surgery training programs and have clinics. Hope this helps.
Tracy M. Pfeifer, MD, MS
Breast Reduction would likely benefit you
Women with large, disproportionate breasts with pain, discomfort or embarrassment due to their breast size are great candidates for breast reduction - you certainly fall into that category given your 32GG breasts . Although ideal candidates for breast reduction are women who are done breastfeeding, breast reduction is commonly performed on younger women if their breasts are causing serious pain and physical discomfort. You must be aware, though, that you may not be able to breastfeed in the future.
Your best bet is to seek consultation with a board certified plastic surgeon. He or she can work with your insurance company to determine whether they will cover the procedure. Best of luck.
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.