I Am 5'5" & 165 Lbs with 38DDD/F Breasts. Would Insurance Cover Breast Reduction Surgery? (photo)

asked 4 months ago by Elyse in New Jersey in Annandale, NJ
Latest answer by Gary M. Horndeski, MD
Question viewed 931 times
Tags: F cup, insurance

Am I a good candidate for breast reduction surgery? Would insurance be likely to cover it?

9 answers to I Am 5'5" & 165 Lbs with 38DDD/F Breasts. Would Insurance Cover Breast Reduction Surgery? (photo)

Body Surface Area determines Breast Reduction criteria

Insurance companies will base breast reduction authorization on body surface area. According to your height and weight, I have calculated your body surface area to be 1.85 meters squared. According to the Aetna protocol, this will require a removal of 715 grams, which corresponds to 3 1/2 cup reduction. The result would be approximately a 38 C. Depending on your desire, a 38 C may not be acceptable to you. Your alternative would be to pay for the procedure... more

Gary M. Horndeski, MD
Houston Plastic Surgeon

www.horndeski.com

Breast reduction surgery

From your photographs it appears that you would be a reasonable candidate for a breast reduction. In most cases this would be covered by insurance but it will differ depending upon your policy.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon

Breast reduction and insurance

It is quite possible that insurance could cover your breast reduction. Each insurance company has different criteria and you may want to investigate what they want. It is best to go for a consultation as well. Good luck.

Steven Wallach, MD
Manhattan Plastic Surgeon

Breast reduction coverage

You are an excellent candidate for surgery based on the size of your breasts and your reasonable weight. Each insurance company has its own protocol and requirements for preauthorization of benefits. Some require conservative medical management, such as physical therapy, chiropractic and documentation of no underlying spinal pathology. Others have much easier guidelines. You should look at your insurance company's criteria, which should be available on its website, for more information... more

Robert L. Kraft, MD
New York Plastic Surgeon

www.foresthillsplasticsurgery.com

Breast Reduction and Insurance Coverage

It appears that you would be an excellent candidate for breast reduction surgery. Your best course of action would be to see a Board Certified Plastic Surgeon that specializes in breast reduction surgery. Your surgeon will know how to approach your insurance to help you get coverage. Different insurance companies have different criteria. Most require that you will need a minimum of 500 grams of breast tissue removed from each breast. Then the insurance company will want documented proof of... more

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon

www.dr-delgado.com

Insurance Coverage Of Breast Reduction

The only way to know for sure if your reduction will be covered is to see a plastic surgeon who can then communicate with the ins. co. to determine prior approval. Some insurance cos. insist on PT, chiropractics, or other conservative treatment and some have outright refusals to cover reduction in policy. Most look at symptoms and amount of tissue to be removed in relation to BSA.

John Whitt, MD
Louisville Plastic Surgeon

I Am 5'5" & 165 Lbs with 38DDD/F Breasts. Would Insurance Cover Breast Reduction Surgery? (photo)

Yes you SHOULD be covered but every insurance has restrictions. Best to see a boarded PSs in your insurance plan and obtain a letter of predetermination. Good luck.

Darryl J. Blinski, MD
Miami Plastic Surgeon

Inusrance Coverage of Breast Reduction Surgery

Breast reduction surgery often causes significant symptoms of neck, shoulder, and back pain. When patients have symptomatic mammary hypertrophy (large breasts), various insurance companies often have guidelines for the amount of breast tissue that must be removed for the surgery to be considered medically necessary. During your consultation, your surgeon will review your medical history and perform a physical exam (which includes taking certain body measurements) to determine if... more

Marcus Crawford, MD
Atlanta Plastic Surgeon

Breast Reduction Candidate?

Thank you for the question and pictures. Based on your pictures alone, I think you may be an excellent candidate for breast reduction surgery. It is very likely that your breasts cause problems such as neck, back, and shoulder discomfort. They may significantly interfere with activities of daily living. Unfortunately, there is no way of knowing whether your procedure will be covered by your insurance company, except for directly contacting them. The best way to... more