Am I a Candidate for a Breast Reduction? Tricare Insurance Coverage?

I'm a 38L and weigh 230 pounds. I have lost 50 pounds since having my child a few years ago, and my breasts are the same size. I have been to the neurologist for numbness in my arms/hands. I've had several MRIs and EMGs done. Ive taken anti-inflammatories, muscle relaxants, and migraine meds. I have shoulder indentations, neck and back pain, pain with everyday activities and exercising, and difficulty breathing while lying down. I've been referred by PCM to plastic surgeon through Tricare.

Doctor Answers (3)

Candidate for Breast Reduction?

+1

    Insurance companies have different ways of determining who is suitable for breast reduction.  You would probably benefit from breast reduction but getting approval from insurance may be difficult given your current weight of 230 lbs.


Los Angeles Plastic Surgeon
5.0 out of 5 stars 178 reviews

Breast reduction and Insurance Coverage?

+1

 Thank you for the question.
Based on your description, you may be an excellent candidate for breast reduction surgery at some point. This operation tends to be one of the most patient pleasing operations we perform.

It is likely that you will benefit from additional weight loss prior to undergoing breast reduction surgery ( or any other type of body contouring procedure).  Achieving a long-term stable weight will increase the safety of the procedure performed and  decrease chances that additional surgery will be “necessary” in the future.

You will need to check directly with your insurance company directly to see whether your policy covers this operation. They will also be able to tell you whether you will have any direct responsibility/expenses if you choose to undergo this procedure.

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.

When the time is right, this documentation and letter/pictures from your plastic surgeon will help you obtain authorization.
 I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 680 reviews

Breast reduction

+1

You  may very well be a candidate for a breatt reduction but should go for a consutation to be properly evaluated.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.