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I Am 5'3,163lbs,and Wear a 34f/g Will Medical Assistance Pay for a Breast Reduction?

I have seen an Orthopedic Dr who suggested Physical Therapy. I did about 5 weeks of that and had to stop because it caused a rib sprain. Both my PCP and Orthopedic Dr.'s have recommended breast reduction surgery. I have an appt with the PS in a few weeks. What is the amount that has to be removed and if it is 500g what size would you assume I would be?

Doctor Answers (3)

Insurance coverage

+1

Every insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX


Houston Plastic Surgeon
4.5 out of 5 stars 128 reviews

Breast Reduction Candidate?

+1

Based on your description and pictures you may be an excellent candidate for breast reduction surgery; it is one of the most patient pleasing operations we perform.

By removing “excess” breast tissue, adipose tissue, and breast skin  this operation reduces and lifts the breasts to a higher position on the chest wall. By doing so, patients often find improvement in neck, back, and shoulder discomfort and find it easier to form their activities of daily living and exercise.

I would suggest that you meet with well experienced board-certified plastic surgeons and communicate your goals in front of a full-length mirror.  You may be able to demonstrate what you are trying to achieve doing so. In my practice I like the use of goal pictures,  to help with this communication process.

Every health insurance company/policy has a different criteria for “approving” breast reduction surgery;  you will need to check with your specific insurance company and policy  for details. The plastic surgeons you meet with will be able to guide you more specifically in regards to what your breasts will look like after removal of the “required” amounts of breast tissue.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 793 reviews

Breast reduction

+1

Each insurance company requires different things to approve a breast reduction. 500 gm removal looks different for different patients.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

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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.