Insurance coverage has gotten more difficult over the years. When I started my practice, most of my reductions were covered by insurance. Now most are not.
Lifting the breast and reducing the size helps with back pain, neck pain, shoulder notching, rashes and infections of the skin under the breast, and posture. It also helps with ease finding clothes and ability to exercise.
Check with insurance to see if “reduction mammaplasty” is a covered surgery with your plan. All plans are different, even within the same insurance company.
Generally a minimum reduction of at least two breast cup sizes is necessary. Many companies adhere to the Schnur Scale to see the amount which must be removed. With current recommendations, a 5′6″ woman who weighs 140 pounds needs a reduction of 370-400 grams per breast to be covered. If she weighs 160, she would need about 450 grams per breast. Liposuctioned fat cannot be applied to this total. For those of us who do the vertical breast reduction (the short scar, "lollipop" not the "anchor" scar), the amount of tissue I directly cut out is less than it used to be.
Having supportive letters from your primary care doctor, chiropractor, physical therapist, or other doctors is helpful. If you have taken medications for skin infections or pain medications for neck and back pain, document it. Many insurance companies require some form of "non-surgical" treatment for your symptoms before they will cover the surgery.
Good luck. I think it is a great surgery. Going from an H to a C/D may get qualified. It all depends on the amount removed.
