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Am I a Good Candidate for a Breast Reduction?

I am 19, and have been suffering from heavy, sagging breasts with nipples that point down since I was about 14. I am 5'4", and around 200 pounds. My bra size is a 38 DDD. They chafe underneath my breasts, and my bra straps dig in. I have scoliosis and hypolordosis. Finding bras and swim suits are impossible, and exerciseis EXCRUCIATING. I love being active, but my large chest makes it painful. unwanted whistling and attention makes me really self-conscious.Can I get insurance being overweight?

Doctor Answers (6)

Am I a good candidate for a breast reduction?

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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, shoulder grooving, etc).

It would be in your best interest for weight loss to increase your safety for Surgery as well as 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.  You should give a description of the therapies that you have done to ameliorate your complaints thus far.  Any other notes from other physicians is helpful.  It would also behoove you to discuss your issues yourself with your insurance carrier.  Hope that this helps!  Best wishes!
Phoenix Plastic Surgeon
5.0 out of 5 stars 6 reviews

Insurance coverage for reduction

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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 101 reviews

Alternative technique to the traditional Wise pattern

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Breast reductions are authorized by insurance companies based on 2 criteria.  First, you must have symptoms related to the large breasts such as neck, back and shoulder pain or rashes.  Second, you must have to amount removed that meets their criteria.  The criteria is based on your height and weight.  At 5'4 and 200 lbs your body surface area is 2.02 meters squared.  If your insurance was Aetna, they would require 965 gram removal.  At size 38 each 200 grams will correspond to 1 cup size change.  5 cup sizes would take you down to a size A or B.  That size would be inappropriate for you.  I recommend you consider an alternate procedure.  There is a new technique called The Ultimate Breast Reduction.  This technique is done without a vertical scar and avoids the boat anchor shaped incisions of the Wise pattern that was developed in 1956.  This technqiue will allo you to select the size proportionate to your body so you will not be overly reduced.  This technique provides immediate pain reliefe by transferring the weight of the breast to the undelying muscle and eliminating the strain on the skin.  You are a good candidate for this technique.

Best Wishes,

Gary Horndeski, M.D.

Web reference: http://www.fastcodesign.com/1663319/how-one-surgeon-is-reinventing-the-female-breast-sfw

Texas Plastic Surgeon
5.0 out of 5 stars 109 reviews

Breast reduction candidate?

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Based on your symptoms it seems you would be a good candidate for breast reduction.  A call to your insurance company will help determine if it's a covered benefit under your policy and any restrictions they have associated with the surgery.  By visiting a Board Certified Plastic Surgeon you'll be able to learn more about the procedure including risks and benefits.  Your surgeon can also assist you in exploring your benefit coverage.  Good luck!

Katy Plastic Surgeon
5.0 out of 5 stars 8 reviews

Breast reduction

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I am so sorry you are living with these large breasts.

  • Yes, your symptoms make you a good candidate for breast reduction.
  • Insurance usually will cover breast reduction - every policy is different. Call your insurer to find out what you need to do, if anything, to qualify for surgery. 
  • large breasts can make exercise impossible, making weight control difficult. 
  • Many breast reduction patients become more active after surgery and lose weight.
  • if you qualify for insurance surgery, consult a plastic surgeon in your insurance plan.
  • they file a pre-determination insurance  report. Once approved, you can have surgery.
  • In the meantime, try to lose some weight to lower surgical risks. 

Hope this helps!

Atlanta Plastic Surgeon
4.0 out of 5 stars 13 reviews

Good Candidate for Breast Reduction?

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I'm sorry to hear about the problems you have experienced secondary to disproportionately large breasts since you were very young. Based on your description, it is clear that you have  suffered both from the physical and psychosocial stamp point.

Also, based on your description  it is clear that you may be an excellent candidate for breast reduction surgery  at some point; it will be in your best interests to drop weight first.  Doing so will help decrease the risks of surgery and help minimize the chances that additional surgery will be come necessary in the event of weight loss that occurs after the breast reduction 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.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you are  consulting with a well-trained/experienced board-certified plastic surgeons.

When dealing with health insurance companies, be prepared to be persistent. Keep in mind, that breast reduction surgery tends to be one of the most patient pleasing operations performed.

Best wishes.

Web reference: http://www.poustiplasticsurgery.com/Procedures/Procedure_breastReduction.htm

San Diego Plastic Surgeon
5.0 out of 5 stars 628 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.