Severe Body Pain from DD Breasts Qualifies for Breast Reduction?

I have been having severe back, neck and shoulder pain for many years now and I have pain in my chest when I sleep and when im awake. I have DD breasts and I want to know if I'm a canadate for breast reduction surgery.

Doctor Answers (15)

Insurance coverage for breast reduction

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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 123 reviews

DD and breast reduction surgery?

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 Insurance coverage is a hit or miss depending on the carrier.  Usually having symptoms related to breast size is necessary for insurance coverage. Getting it covered though is very difficult. Insurance companies wont tell anyone how much tissue needs to be removed to qualify for coverage. Then if the surgeon is 1gram off they deny coverage after the fact. Insurance companies make money by denying coverage. For that reason most plastic surgeon will likely ask for payment up front.  Breast reductions are the most gratifying operations because years of neck, back and shoulder pain are gone within days.  The final size result depends on your starting size. If you start larger then you will likely end larger. It is not possible to choose a size with any real accuracy. The main reason is that the procedure removes breast tissue but leaves enough tissue to preserve the blood supply to the nipple and areola. Thus more tissue needs to be left behind to ensure nipple viability. The nipple and areola is constantly being accessed during the operation. See a board certified plastic surgeon for specifics on your treatment.

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Raj S. Ambay, MD
Tampa Plastic Surgeon
4.0 out of 5 stars 15 reviews

Breast reduction insurance coverage

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It is important to rule out other sources of  neck and back (and in your case chest) pain prior to proceeding with breast reduction surgery; otherwise you may be disappointed if the symptoms persist despite having had the surgery. If your symptoms are related to large breasts then the chances that you will be please with results of surgery (and the relief of symptoms) are very high.

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. Make sure you're saying a well-trained/experienced board-certified plastic surgeon.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 756 reviews

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Candidate for Breast Reduction

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Many patients who are candidates for breast reduction will have back, neck and shoulder pain. Consult with a plastic surgeon to discuss your situation and to determine if your symptoms are indeed related to breast enlargement.

Leo Keegan, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 2 reviews

Breast Reduction Surgery

+1

A consultation and examination with a board certified plastic surgeon would help you answer your question.  Check with your insurance company to determine if a breast reduction is a covered benefit. Also ask about their specific criteria for coverage. Please note that every insurance company and plan is different. Best of luck!

Christine Sullivan, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 19 reviews

Breast reduction

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You may very well be a good candidate for a breast reduction, but an exam is in order to see what can be done for you.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

DD breasts great for breast reduction.

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Hi.

You are a great candidate for breast reduction.  Are you asking if you would have insurance coverage?  I wrote an article about this for RealSelf which you can read at the bottom of my profile.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast Reduction Candidate

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You certainly may be. I would want to know your height and weight and your bra size. If you are trying to cover this under insurance, that is what they look at. Your BSA is calculated and then a determination is what as to how much breast tissue needs to be removed for this to be medically necessary.

If you are not planning to do this under insurance, then we can determine how much breast tissue you would need to be removed.

Hope that makes sense, you very well may be a candidate to have your breast reduction under insurance but I cant answer that unless I have more information.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 39 reviews

Does body pain and DD breasts make you a candidate for breast reduction surgery?

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Back, neck, shoulder pain as well as irritation of the skin between and under the breasts are all symptoms that can be caused by large breasts. Since you are suffering from some of the above, you will likely benefit from breast reduction surgery. A consultation with a surgeon certified by the American Board of Plastic Surgery will help define in what ways your breasts are contributing to your discomfort and what improvement you can expect from breast reduction. It certainly sounds like your symptoms warrant a consultation.

Elizabeth Slass Lee, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 33 reviews

Breast reduction candidate

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It sounds like you are an excellent candidate and would be very happy with breast reduction results. The usual criteria are large breasts, neck, back and shoulder pain, breast pain and, irritation of skin under the breasts and failure on conservative treatments and documentation of those treatments.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 17 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.