Will my Insurance Cover Breast Reduction and Tummy Tuck?

Dear Dr.,

I am a mother of 4 and even though I eat healthy food and exercise 5 times a week, I am not able to lose the weight. I have been considering Lipo and Tummy Tuck.

I also have large breast (38DD) which causes me to get rashes between the breast and the ribcage. I also get constant back aches and shoulder pains. I'm thinking about Breast Reduction, too. Will my insurance pay for these procedures or at least part of the procedures? Thanks.

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back breasts shoulder DD cup pain weight loss exercise insurance

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10 Doctor Answers | Asked by lizzie74 in North Jersey

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Breast Reduction and Tummy Tuck - Insurance Coverage

Good question! In general, insurance coverage for breast reduction may be available depending on how much breast tissue is being removed (it's actually a function of that, plus your height, weight and any mitigating medical or health issues...each insurance company has its own criteria). However, if you are a 38 DD then you may not be happy if enough tissue is removed to satisfy the insurance requirements (ie, you may then be too small). That's something you'll... more

Breast Reduction, Tummy Tuck and Insurance Coverage?

Thank you for the question. You will have a much better chance with the insurance company covering the breast reduction surgery as opposed to the tummy tuck surgery. Consultation with a well experienced board-certified plastic surgeon will be helpful. Best wishes.

Breast reduction and insurance coverage

Dear Izzie, your insurance company will probably cover the breast reduction. Your doctor will probaly have to submit your photos and an explaination of your symptoms to them and get preauthorization prior to your surgery. Unfortunately, they usually will not cover tummy tucks.

Insurance Coverage for Breast Reduction and Abdominoplasty

We have had much success with insurance coverage for breast reductions for patient who have pain and rashes due to the size of their breasts. Often times, the insurance company will ask that the patient seek conservative treatment prior to insurance approval. Conservative treatment may include wide strapped bras, over the counter medications, chiropractic visits, etc. It is best to check your specific insurance plan to determine if breast reduction coverage may be available. the... more

Breast reduction and tummy tuck insurance coverage

You will probably have more success seeking coverage for the breast reduction. Insurance companies wil not cover abdominoplasty surgery unless you underwent gastric bypass surgery and had massive weight loss with an overhanging pannus. They may cover the pannus removal and not the muscle tightening or umbilicus repositioning. And this is only for a handful of patients.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Insurance coverage for breast reduction.

Insurance Coverage for Breast Reduction 80% 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 C cup) will usually be covered. 3) Many policies will pay for breast reduction if... more

Insurance will not cover Breast Reduction and Tummy Tuck

No. No insurance company that I know will cover BOTH a tummy tuck (a cosmetic surgery) and breast reduction (each company has different criteria for what they cover). IF you policy has "BREAST REDUCTION BENEFITS" it MAY pay for your surgery PROVIDING the surgeon (who must be a "participating" plastic surgeon -- not all of us "participate" will all plans) removes a pre-set weight of breast from each side. Since each company differs, I would suggest that IF you... more

Insurance covering tummy tuck and breast reduction

Insurance companies are difficult to deal with when it comes to plastic surgery. They only cover "medically necessary" procedures and they (not the patient or doctor) decide what procedures are medically necessary. Having said that and from your description, there is a reasonable chance your insurance carrier will cover the breast reduction (but there are many hoops to jump through) and little chance they will cover your tummy tuck. In my experience, the amount of excess... more

Insurance Coverage of Breast Reduction & Tummy Tuck

There is a possibility that your insurance will cover a breast reduction, depending on your symptoms and the estimated weight of tissue to be removed. It is very unlikely that your TT would be covered. You should seek consultation with a Board-certified Plastic Surgeon who could give you a better idea of costs and coverages with your policy.

Insurance Coverage for Breast Reduction

I usually ask patients, seeking breast reduction and abdominoplasty if they and their spouse have finished your family before offering them surgical solutions. These operations are not incompatible with a full-term pregnancy and lactation, however the results will be negated, afterwards. Generally, insurance will only partially pay for procedures which are not considered "cosmetic", thus tummy tucks and liposuction are automatically excluded. Breast reductions are a larger... more