Will Insurance Allow Breast Reduction from F to D Cup?

asked 2 years ago by GarrisonJ in Texas
Latest answer by Francis (Frank) William Rieger, MD
Question viewed 1,131 times
Tags: age 25-34, back, neck, female, 150-169 lbs, 5 ft 4 in to 5 ft 7 in, breast feeding, D cup, F cup, insurance, pain

I have always been large breasted and have always wanted a reduction. In the past 2 years, I have given birth to two children and breastfed. My youngest is now a year old and my breast have not returned to "normal" size. I am still wearing my maternity, size F bras. My back and neck hurt all day long. As I said earlier, I have always been large breasted. Will insurance allow me to be a size D, or must you go really small? Am I a good candidate for insurance to cover my breast reduction? I am 33 years old, 5'7", and 165 lbs.

10 answers to Will Insurance Allow Breast Reduction from F to D Cup?

Breast reduction and insurance coverage

I believe that every Plastic Surgeon would consider your request very appropriate considering your current breast size. The decision rests with your insurance company, however, and this often is a challenge for the well deserving patient. Always use the advise of your local Plastic Surgeon in trying to increase the possibilities for approval for your request. You may be asked to try to lose some weight, engage in physical therapy or chiropractic care for a... more

Francis (Frank) William Rieger, MD
Tampa Plastic Surgeon

Breast reduction insurance coverage

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... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

If breast reduction is performed to improve functionality by relieving pain in the

Neck, shoulders and back, or to relieve chronic infections where the breast meets the skin of the chest wall, then insurance may cover the procedure. Often the insurance coverage will depend on how many grams of breast tissue are removed in the reduction, but you appear to be someone who would qualify on that basis. Each insurance company has heir own criteria to determine coverage, and you will need to work with the plastic surgeon you consult with to obtain pre-approval for the... more

Michael H. Rosenberg, MD
White Plains Plastic Surgeon

Insurance coverage for breast reduction

Each insurance company has different criteria for pre-approval of a breast reduction surgery and you should contact your carrier.

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance coverage for breast reduction.

Insurance Coverage for Breast ReductionView Edit Answer by George J. Beraka, MDManhattan Plastic SurgeonContact the doctor80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points. 1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches. 2) Very big reductions (like from an F cup to a... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast reduction and insurance coverage

Hi, insurance companies are notoriously difficult when it comes to coverage for a breast reduction. Every company has a different standard, but in general they want to see a minimum amount of tissue off per breast prior to agreeing to coverage. You look and sound like you would be a good candidate to be covered by most companies. I would suggest calling your insurance company to check their policy. When you see your surgeon, his or her office should be able to facilitate sending in the... more

Nina S. Naidu, MD
New York Plastic Surgeon

Medical insurance coverage varies between plans

Although you appear to be an excellent candidate for breast reduction, whether your insurance will pay for it depends entirely on your plan. Insurance coverage varies between companies, and even between different plans in the same company. Generally, however, most plans will cover breast reduction if the following criteria exist: 1) Back pain (from breasts being too big) 2) Bra strap grooving on the shoulders. 3) Rash in the lower breast fold that does not respond to medical treatment. 4)... more

Kevin Brenner, MD
Los Angeles Plastic Surgeon

Breast Reduction Insurance Coverage in Texas

Most of the plans I have worked with will allow a reduction if we are anticipating removing over 500 grams of tissue. For reference, a can of soda is about 350 grams. The only way to tell is have your PS call your INS company and check your benefits. At my Houston practice, I perform breast reduction through a short lollipop-shaped scar, instead of the older anchor-technique. Some photos at: http://www.drlomonaco.com/dev/houston-breast-lift.shtml

John LoMonaco, MD
Houston Plastic Surgeon

Insurance may or may not pay for breast reduction

You appear to be an excellent candidate for a breast reduction BUT it really is not up to you. If you are like most Americans, when you or your employer purchased your medical insurance, the policy may or may not have a rider covering breast reduction benefits. If your particular policy does not pay for breast reduction, stop here. They will NEVER pay for it and it has to come out of your pocket. If your policy does pay for the procedure, be aware that EACH insurance company has its own... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Candidates for breast reduction

Based on your height, weight, and breast size, you look like an excellent candidate for a breast reduction. Criteria differ but most insurances require 500 grams be removed from each side. This equates to one pound per side. What cup size this equates to is not possible to say. Many plastic surgeons no longer work with insurance and as such are not constrained by these size restrictions so the reduction can be customized to the size you want and not just to achieve a weight reduction.... more