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Am I a Good Candidate for Breast Reduction? I Have BCBS and Currently Live in ND.

I'm an 18 year old female, I'm 5'5 and 170 pounds, small frame and have fairly large breasts. Even at my healthy weight at 120 I had large breasts, at about a 36D. I am in the process of losing weight but my back and neck soreness is getting to me. I'm always slouching due to my breasts and they are becoming saggy and I can't stand the extra weight on my chest. I'm wondering if I'm a good candidate for breast reduction? I have BCBS and I currently live in ND

Doctor Answers (6)

Insurance

+1
Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX


Houston Plastic Surgeon
4.5 out of 5 stars 123 reviews

Am I a good candidate for breast reduction?

+1
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 and good luck!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Breast Reduction Candidates

+1

The best candidate for a breast reduction has a combination of disproportionately large breasts and associated symptoms of midscapular back pain, neck pain, bra strap grooving and a recurrent rash beneath the breasts.  Breast reduction surgery alleviates these symptoms in the majority of patients.  In the hands of a board certified plastic surgeon, patients are usually quite happy with both the cosmetic and functional improvement.  In general, the procedure is performed with few risks and can often be performed on a outpatient basis. 

 

Insurance providers have different standard for preauthorization for this procedure.  It would be prudent to check your membership materials to find out what these requirements are.  A preauthorization letter from your plastic surgeon is generally required.  Often this is based both on symptoms, the patient's BMI (body mass index), and amount of breast tissue expected to be removed from each side.

Glen Brooks, MD
Springfield Plastic Surgeon
5.0 out of 5 stars 1 review

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Breast reduction and insurance

+1

Every insurance company is a bit different regarding coverage for breast reduction surgery. Certainly if you have large breasts, and significant symptoms related to is, then it is very possible. WIthout an exam I could not be sure.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Insurance coverage for breast reduction

+1
We have to make a distinction between whether you are a good candidate for surgery and whether that surgery will be covered by your insurance company. A D cup would be too small for most carriers at your height and weight and many will require proof of conservative medical treatment prior to approving surgery. If you are losing weight, it would be best to have the surgery after your weight is stable. I also recommend that you see a board certified plastic surgeon who can write a preauthorization letter on your behalf to BCBS or, at minimum, advise you on the nuances of what its rules require at this tme.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 12 reviews

Good Candidate for Breast Reduction Surgery

+1

Thank you for your question.  If your large breasts are contributing to your back and neck pain, then you are a good candidate for breast reduction surgery.

Each insurance company is different with what they require to "authorize" the breast reduction surgery through insurance.  I write a letter and send photos of the patient when trying to get authorization (I am sure most plastic surgeons do this as well).  Also getting supporting letters from other doctors who can document that you have had neck, back and shoulder pain and/or rashes due to the large breasts. Supporting documentation is usually very helpful.

This is one of our most patient pleasing operations.

Best Wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 751 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.