I am 5'4", 150 lbs. I am beginning to schedule consultations for a reduction and/or lift. Approximately how many CCs will be removed for this kind of reduction? What is the minimum most insurance companies would approve for someone my size? From a professional perspective, does my desired size seem suitable? I would like to be able to exercise more comfortably, reduce back/neck pain, and be able to fit into standard sized bras... but I have an hourglass shape and athletic build and still want that full, curvy look.
I Wear Size 32H, Hoping to be Size 32DD After Reduction, How Many CCs Would that Require? (photo)
Doctor Answers (10)
Breast reduction - how much to remove?
When patients see me for a reduction, they have 3 choices. We work towards removed just enough to satisfy insurance company requirements, I do the procedure as I normally do and you end up usually being a generous C or small D cup, or we are aggressive and maximize the excision/reduction and accept whatever cup size that results in.
You cannot get a guarantee on what cup size you will have. There is no reliable way to do this. if you are doing this cosmetically, you dictate how much volume you want to remove and accept whatever result comes from that. Hope you can achieve what you are desiring through communication with your surgeon.
Breast reduction issues
Removing breast tissue is measured in grams rather than cc's and unfortunately there is no way to measure or know the amount before the procedure and it does not correlate well with cup size of the breast. The way to think of it is that the surgeon needs to remove breast tissue from the appropriate areas until the desired size and shape is left. The tissue removed is then weighed and checked by pathology exam.
If you use an insurance company including government plans, you are asking someone for permission to do what you want and feel you need but since they pay for it they get control over whether you can have the surgery, who can do it for you, where you can have it done, and how much tissue has to be removed in order to qualify (which can't be known with any surety before the procedure). I approach this as rightfully the patient's choice and it doesn't matter whether it's a lift or a reduction or how much is removed. The patient is in control and decides if she wants the surgery but has to bear the cost.
For functional issues and symptoms, the way to understand it is that the female body/chest is built to handle A, B, and C size breasts relative to the chest around but sizes larger and heavier than that can and will cause problems. Therefore, to correct the functional issues, the breast needs to be reduced to a full C or borderline D in order to be assured of proper proportions and symptom relief. There is no reason this has to be done if the patient is in control and understands the issues. Lifting the breast without removing any tissue or reducing it to a DD cup size is certainly possible if the patient has the choice. Remember also that there is no exact measure of bra cup sizes.
Grams removed during breast reduction.
Only a physical exam would allow a plastic surgeon to know how approximately how many grams would be removed to reduce your breasts to your desired size. Younger women tend to have more dense / heavier breast tissue as opposed to older women where the tissue is less dense and lighter for a given breast size. Most of my patients are looking for their breast size to be proportional to their body size after the surgery. How many grams it takes to accomplish that varies patient to patient. Insurance companies vary widely on the amount of weight which needs to be removed for them to pay for it as a reduction. Some use your height, with more grams required the taller you are, some use BMI (body mass index) and some use BSA (body surface area). Both BMI and BSA are formulas using your height and weight to determine the grams to be removed. Your plastic surgeon, after meeting with you and determining what your insurance coverage is, will know what will be required.
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Your breasts do seem out of proportion to the rest of your body. How much needs to be removed is not easy to determine preop. Since your right breast is larger more tissue will need to be removed from that side. As far as how much insurance requires varies according to the insurance company. Some have a standard 500 gram minimum. Occasionally that number can be smaller based on your body mass index (BMI), or Body Surface Area (BSA). This is called the Schnur scale based on Height and weight.
A consultation with a board certified (ABPS) plastic surgeon will answer your questions further.
Reduction Measured I Grams Rather Than CCs
The amount of tissue removed in a breast reduction is measured in grams (454 grams=1 pound). You have a fair amount of asymmetry of your breasts (which breast fits best in the H cup bra?). I agree with Dr. DeMars that a consultation with a BC plastic surgeon can result in the answers to your questions.
Unfortunately ccs don't correlate with cup size, there are too many other factors involved. But based on your photos I think you will be thrilled with the results of a reduction. See a surgeon for consultation and he will contact the insurance company to see if your carrier will cover it. Your goal size is realistic.
Every insurance company is a bit different. Many go by body mass index and determine a weight of the specimens removed. Often around 500 gms per side( about 1 pound). Pre authorization is often needed.
H to DD , how many grams need be removed?
Breast Reduction Candidate?
Thank you for the question on picture.
Based on your picture and your description of goals I think you may be an excellent candidate for breast reduction surgery. This is one of the most patient pleasing operations would perform.
Unfortunately, there is no direct correlation between the amount of tissue removed and the ultimate cup size that a patient will wear after breast reduction surgery. Also, unfortunately no plastic surgeon can promise a specific cup size that you will fit into after the breast reduction procedure.
Before undergoing the breast reduction procedure it is very important to communicate your size goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or DD cup” or "full, curvy look" means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
Sometimes a procedure is covered through health insurance. 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. The amount of breast tissue reduction that insurance companies require may vary from one company to another; you will have to check with your specific insurance for precise information in this regard.
Make sure you're working with a well-trained/experienced board-certified plastic surgeon.
Choose what YOU want, NOT what your insurance company wants
If you currently wear a size 32 H and desire a 32 DD, that is 3 cup size reduction. For a size of 32, that corresponds to approximately 300 cc volume. From your height and weight, your calculated body surface area is 1.75 meters squared and according to Aetna insurance table, that would require about 600 grams be removed. A 600 gram removal will make you much smaller than you desired, a DD. My advice to you is to choose the size you want rather than make a decision based on what an insurance company will pay for. There is a new technqiue called the "Ultimate Breat Lift" which is able to reduce back, neck and shoulder pain without large volume reductions. This is based on the principal transferring the breast weight to the underlying pectoral major muscle. This can be done without the unsightly boat anchor shaped incision of the Wise pattern which was developed in 1957. Additional benefits are there is upper pole fullnes, maintenance of nipple sensitivity and the ability to breast feed.
Best of Luck,
Gary Horndeski, M.D.
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.