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Am I a Good Candidate for Breast Reduction with my Insurance

I am currently 24 years old 111-114lbs and wear a D cup or DD if the brand runs small. I try to exercise by doing something low impact such as pilates and find myself in pain at the end of the work out. My posture has gotten worse and I slouch. My back shoulders and neck hurt on a daily basis and find myself wanting to sit down because of the back pain. I'm not really sure what to do.

Doctor Answers (13)

Am I a good candidate for breast reduction with my insurance?

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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, etc).

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.  Hope that this helps!  Best wishes! 


Scottsdale Plastic Surgeon
5.0 out of 5 stars 11 reviews

Insurance Coverage and Breast Reduction

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Insurance coverage of breast reduction surgeriess is more difficult to obtain than before.  

Some policies don't even cover breast reduction surgeries, while those that do have a number of requirements.

In addition to large breast size,  you must have neck or back pain that has not responded to physical therapy, and have a insurance mandated minimum amount of anticipated breast tissue removal.

Based on the information, your provided you probably will be covered,  Your plastic surgeon's office will need to submit photos and provide documentation of any back and neck pain symptoms you may have to the insurance company for approval.

 

Fredrick A. Valauri, MD
New York Plastic Surgeon

Breast Reduction Candidate?

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Thank you for the question.

Based on your description you may be an excellent candidate for breast reduction surgery. It is one of the most patient pleasing operations we perform.

Your first step may be to visit with a few well experienced board-certified plastic surgeons to discuss your situation.  Educate yourself about the operation, the benefits as well as the risks/ complications of the procedure. Timing of the operation ( with regards to psychosocial situation and/or planned pregnancies)  may also be a consideration.

Again, check the credentials/training/ experience level of your consulting surgeons carefully. 

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 703 reviews

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Candidate for reduction

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It sounds as thouhg you may be a candidate for a reduction since you are os active and large breasts can get in the way.wheter insurance will pay is possible after your photosand report from the plastic surgeon are sent to your insurance carrier to see if they would pay. 

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 14 reviews

Insurance Coverage of Breast Reduction

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There is no standard among insurance companies for the coverage of breast reduction (except for always attempting to avoid covering this procedure) and, in fact, some insurance policies have an outright exclusion for reductions and will not cover them under any circumstances.  With your small frame, cup size, and symptoms your surgery should be covered unless your policy contains the exclusion.

John Whitt, MD
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast Reduction - Will I Get Relief With A Small Reduction, and Will It Be Covered by Insurance?

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Hi marie386,

There are two issues here:

(1) Would you benefit from a breast lift or reduction and (2) Will your procedure be "covered" by insurance.

For a full and complete answer you would, of course, have to be assessed by someone who can talk to you and examine you in person, but here are a few thoughts.

With respect to (1), even a small reduction (basically a breast lift, since removing less than about 10 ounces of tissue from each side is generally considered a lift even though it's essentially the same procedure as a reduction) can provide dramatic relief of neck and shoulder pain, in addition to making you look and feel better in clothing (and out...).  Whether or not it's worth the resultant scars (usually around the areola and down like a lollipop; sometimes (depending on what you look like and want to look like) also with a horizontal scar in the crease), is something you'll have to decide.  In general, the more tissue being removed, the more comfortable I feel the typical patient with those scars but it's competely individual - the main thing is for you to be well-informed about the process and the likely results, and then you'll make the right decision for you.

The insurance is a separate issue.  Each insurance company is different and requirements for "coverage" vary tremendously.  You would need to see a few plastic surgeons to get their opinions, and then you'll need their help to assess your level of coverage.  I put that in quotations because what the insurance company indicates is adequate payment for the surgery may not be the same as what your surgeon feels is appropriate.  So, either way, you'll need to explore this aspect with your plastic surgeon.

With a few good consultations you'll be able to make an informed decision.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 148 reviews

Breast Reduction and Insurance

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Every insurance company is different, so you really need to check your own policy and discuss your options with a plastic surgeon in your insurance network.  They would be the best to know if you may qualify or not under your plan.  

 

Good Luck.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 55 reviews

Breast Reduction and Insurance

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Each insurance company has their own criteria to determine if a breast reduction will be covered. Then many insurance companies have different policies within their own company. You need to check with your insurance company and find out if a breast reduction is even covered under the policy you have. If it is, I would then recommend that you have a consultation with a Board Certified Plastic Surgeon (even two or three until you find one you are comfortable with). Your plastic surgeon will be able to help you get pre authorization if he/she feels you are a candidate. It is important to have documentation of other methods you have tried unsuccessfully to alleviate your discomfort of heavy breasts, such as physical therapy, good support bras, etc. Many insurance companies base their approval on the amount of tissue to be removed, usually the minimum is 500 grams per breast. Your surgeon should be able to know on examination if you meet the criteria. Good luck!

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 29 reviews

Am I a Good Candidate for Breast Reduction ?

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You SOUND like you would benefit from a Breast Reduction but this does not mean that YOUR insurance company would approve the surgery.

The first thing you need to do is find out if your particular policy pays / covers Breast Reduction Surgery. If you do NOT have "Breast Reduction Benefits" it does not make a difference if you have all the symptoms in the world; Since you ? your employer did not pay premiums for breast reduction benefits such surgery would not be covered. If you DO have such coverage, find out which Plastic surgeons in your area participate / work with your insurer. This information may be in your brochure or on the insurer's website. Pick several names and research them. Then go see several of them and see which surgeon you like the best. The surgeon will write a letter to your insurer asking for permission to do your surgery. When the insurer gives its permission your surgery can be scheduled.

Good Luck.

Dr. Peter A Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 59 reviews

Am I a good candidate for a breast reduction

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Dear Marie,  insurance carriers have diferent criteria for coverage.  The only way to know if the surgery will be covered is to submit a letter for predetermination.  This is done by your PS.  He will submit photos and estimate the amount of breast tissue to be removed, as well as describe your symptoms. Most companies have a minimum tissue weight requirement based on your  BSA(body surface area) and many companies  require an attempt at conservative intervention such as physical therapy to reduce the pain before authorizing the procedure.  Good Luck. 

Beverly Friedlander, MD
Short Hills Plastic Surgeon
5.0 out of 5 stars 8 reviews

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.