Would I Be Approved for Breast Reduction Surgery if I Am 5"0 210lbs 48f Bra Size?

Hi! Im 31 5"0 210 with a 46 to 48f bra size. I was denied last year for br because of my BMI, but i have explained to my PCP that in order for me to exercise properly, i would really need the surgery. I have United Healthcare now but im afraid they wouldnt consider the surgery medically necessary. I have severe back pain/neck pain issues and pinched nerves due to having large breasts and my posture is out of place. I really need this surgery!!

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F cup candidate

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9 Doctor Answers | Asked by tstarr in Dallas, TX

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Breast reduction insurance approval

Thank you for this important question. I have no doubt that you could get symptomatic improvement with breast reduction surgery. And, documenting your breast size and the symptoms you have is important. Unfortunately, your current BMI is 41 and, in my experience, insurance will often decline breast reduction requests in that BMI range. I suppose the assumption is that weight reduction would likely result in some reduction of breast size. Keep in mind that your... more

Breast Reduction - Would I Be Approved for Breast Reduction Surgery if I Am 5"0 210lbs 48f Bra Size?

Good question, but no plastic surgeon can answer this for you. Whether or not this, or any other, procedure is "covered" by insurance depends on specifics of your insurance policy. Two people who have the same shape and size may be treated differently depending on their insurance policies (one may be approved; the other denied). The best way to approach this is to have your plastic surgeon contact your insurance company on your behalf (you can do this on your own,... more

Breast reduction approval

If United categorizes you as having gigantomastia, then the weight would not be a factor. In 2010, United changed its criteria to require that patients prove that the size of the breasts interferes with activities of daily living. If you have documentation of back/neck issues, including neuropathy, then they may approve the surgery regardless of your BMI. It's important for you to obtain a referral to see a board certified plastic surgeon as I find, as a rule, that internists are... more

Breast reduction

Each insurance company has different criteria regarding BMI and breast reduction approval. You should call your insurance company and find out their policy.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Insurance for Breast Reduction

Unfortunately you are asking your question of the wrong people. We know there is no question at all that your surgery is medically necessary. You would have a major and lifelong benefit. But whether or not your insurance company covers it is up to them. Remember the insurance company is in business to make money. They make money when you pay them, not when they pay you. Their arrangement with you is contractual and clearly spelled out. You may need to seek a new health carrier, or as more... more

Insurance coverage for breast reduction.

Hi. I hope you find this article useful. Good luck! 80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points. 1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches. 2) Very big reductions (like from an F cup to a C cup) will usually be covered... more

Breast Reduction and Insurance Coverage?

Thank you for the question. No doubt you will be an excellent candidate for breast reduction surgery; it is one of the most patient pleasing operations we perform. As you know, timing of the surgery is patient specific; ideally, it is best done when a patient is as close as possible to a long-term stable weight. Unfortunately, there is no way of knowing whether your procedure will be covered by the insurance company, except for directly contacting them. Your plastic... more

Breast Reduction and Insurance

Different insurance companies have different criteria for approval for breast reduction surgery. You might try seeing a plastic surgeon and have him or her try to get approval for you. Surgeons are very familiar with the process and may have better luck. However, if you are turned down again ask your surgeon to request an appeal. Many times an approval will come through on appeal as a doctor for the insurance company will contact your surgeon and get more detailed information specific... more

Breast Reduction: Getting Insurance Approval, what are the criteria?

Breast Reduction Surgery is one of the highest satisfaction procedures that plastic surgeons perform. Patients often present with significant symptoms that result from the heavy, pendulous nature of the breasts. Some of these symptoms are neck, back and shoulder pain, knee problems, rashes and shoulder grooving. Surgical reduction does more than create beautiful, balanced sensual shape; it relieves the chronic symptoms almost immediately. Insurance companies often... more