There are a multitude of procedures referred to as breast reduction, including simple liposuction. Some involve long scars and some short. From an insurance point of view, the only real concern is relief of the weight of the breast producing neck, back, or shoulder strain. This can potentially be accomplished with just liposuction without regard to shape, form, or aesthetics of the breast.
Breast lifts generally address the shape and form of the aesthetics of the breast. I do not know why your surgeon is charging extra if he is using a traditional skin reduction pattern reduction since this incorporates the lift, however one can be quite picky and break down the traditional reduction into its pieces (i.e. removal of weight, shaping of skin, lifting of nipple, reducing size of nipple) and charge a la carte.
I suspect it is in much part due to what is being allowed as a fee by your insurance. If your surgeon is not part of the insurance plan, then he may be free to charge anything he wishes without regard to the insurance reimbursement. This would be quite normal as the insurance payment usually is far below the going rate in private practices outside of insurance plans.
If he is in the plan, he might justify he charges by saying the insurance will pay for removal of the weight without regard to the aesthetics, say by liposuction, and that you will need to pay to have him shape it to look the way you want, and that is something the insurance may not pay for.
The insurance company might say it is all-inclusive and not have to worry about what is included because they are paying a self-determine fee anyways. It can be a fuzzy area.
