Will Insurance Allow Breast Reduction from F to D Cup?

Thank you for your question.
You may be a candidate for breast reduction surgery. Contact your insurance company for the requirements/criteria to have this surgery approved. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

#Breastreduction : size and insuranceIn general when the #excessivebreastsize causes functional problems, insurance will generally pay
for the operation if more than 400 – 500 grams are removed from each breast
dependent on your individual insurance company requirements.

Hello! Thank you for your question.  It is a safe procedure, in which your plastic surgeon will reduce the amount of breast tissue, reshape your breasts, raise the nipple-areolar complex to its appropriate position (possibly making the size smaller, if needed), and ultimately ameliorate the possible complaints that you do have for the reason that you are having this procedure (e.g., neck/back pain, migraines, rashes/infections, shoulder grooving, etc).  Your complaints certainly sound as if you would be the ideal candidate for a breast reduction.  Cup size alone is not mandatory, but sometimes the amount of tissue removed - enough should be excised to ameliorate your complaints.It would be in your best interest to have a mammogram prior to the procedure for screening prior to this procedure, as the architecture imaging of your breast will slightly change afterwards. Well known data exists that having a breast reduction will in fact lower your chance for developing breast cancer, simply because the amount of tissue will be less.Consult with a board-certified plastic surgeon who will discuss the procedure with you, examine, and assist you in determining if this is the right procedure for you.  Voice your complaints - your insurance will likely require a detailed description of your history and complaints as well as photo and an estimate of how much tissue will be removed.  You should give a description of the therapies that you have done to ameliorate your complaints thus far.  Any other notes from other physicians is helpful.  It would also behoove you to discuss your issues yourself with your insurance carrier.  Hope that this helps!  Best wishes!

I find that there is a large amount of variability in breast size when patients say they wear an F-size bra.  It is best for you to consult with an expert plastic surgeon to accurately estimate the weight that you will remove with breast reduction surgery.

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) Your surgeon believes that a minimum amount of tissue can be removed (usually 500 gms per side, sometime less)

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

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

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. Good luck!

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 surgery.  If you have seen another physician for symptoms related to your breast size, careful documentation of those encounters, as well as good "pre-operative" photographs, can help you obtain pre-approval for the surgery. 

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