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Approximate Minimum Amount Removal for Insurance to Cover a Reduction? (5'2, 130lbs, 34DD/DDD)?

I am 20 years old, 5'2, 130lbs and have size 34 DD/DDD breasts. Does anyone have any idea what the minimum amount that my insurance (Cigna) would require to be removed? Or, what is the minimum amount required by other insurance companies (in general) for women of this build? I am aware that this question is nearly impossible to answer accurately without an exam. But if anyone has any approximations or anything from a similar situation, I would greatly appreciate any info! Thank you!

Doctor Answers (8)

Gram weight for breast reduction

+2
The usual minimum in NY is 500 grams per breast. Occasionally, Cigna will authorize a case in the 450 gram range on a petite woman but will require documented conservative management such as physical therapy or pain medication for at least 6 months. The current guidelines, which they treat as gospel, are available on the Cigna website.


New York Plastic Surgeon
5.0 out of 5 stars 12 reviews

Usually over 500gm/side

+2

Each company is different --- call them and ask. They might not give you a straight answer, but remind them that y ou pay them for insurance and they should be responsive to you.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.0 out of 5 stars 9 reviews

What is the minimum amount of tissue to be removed in breast reduction to get insurance coverage.

+2

Thank you for your question. 

Unfortunately, getting breast reduction covered through Health Insurance has become increasingly more difficult.  Each insurance carrier has specific guidelines and rules and many of them can vary.  In my own area some insurance carriers require prior authorization and review of photographs before they make a commitment.  Many of these companies also require a minimum of 500 to 600 g be removed.

If you are truly a triple D size breast it is likely that your surgeon will remove enough tissue, but certainly the amount removed will affect your size so you have to be certain that you are getting what you want.

Many insurance carriers will no longer give approval prior to surgery.  They send a letter explaining that they will determine benefits after the procedure.  Unfortunately, this approach can lead to significant financial liability on the part of the patient.  I always recommend that my patients obtain a guarantee of payment from their insurance carrier prior to surgery so that they have no surprises.

 

Hope this helps.

Adam Tattelbaum, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 51 reviews

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Ultimate Breast Reduction alternatie to Wise pattern

+1

At size 5'2 and 130 lbs your body surface area is 1.6 meters squared.  Using the Aetna table, they would require 460 gram removal.  At size 34 each 100 grams corresponds to 1 cup size change.  If you are a DDD that would take you down to between an A and a B.  That would be an excessive amount of removal and you will be dissatisfied with the result.  Insurance companies require this in order to discourage you from doing the procedure.  There is an alternative technique called The Ultimate Breast Reduction, which relieves pain by transferring the weight of the breast to the underlying muscle.  This is done without a vertical scar and maintains the size proportionate to your body size.  Breast feeding and nipple sensitivity are maintained and surgery is performed without the ugly vertical scars as in the Wise pattern that was developed in 1956.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 127 reviews

Breast reduction requirements for insurance

+1

Insurance companies look at many different variables when coming up with a weight to remove from the breasts.  These include; height, weight, various breast measurements, and pictures of your breasts.  Most insurance companies require a weight that leaves you approximately a B cup after surgery.  This can vary depending on your body habitus and BMI. Meaning, they could require 500gm per breast for a woman 6ft tall and only 250gm for someone 5ft.  The best thing to do is see a plastic surgeon and discuss the options. I hope this helps you.

Kindest regards,

Neil J. Zemmel 

Neil J. Zemmel, MD, FACS
Midlothian Plastic Surgeon
5.0 out of 5 stars 58 reviews

Breast Reduction and Insurance Coverage?

+1

Congratulations on your decision to consider breast reduction surgery; this operation is one of the most patient pleasing operations we perform.

 Unfortunately, there is no way to predict with any accuracy what a specific person's  specific policy requires when it comes to weight reduction surgery.

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.

Also, when dealing with insurance companies, prepare to be persistent...

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 759 reviews

Minimum breast reduction

+1

There is no specific minimum breast reduction volume that a given insurance company will deem for all patients. It is based upon your height and weight.  Many insurance companies make it very difficult to cover this procedure.

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

Required minimum Amoun of breast tissue removed for insurance coverage

+1

Mostof f the insurance companies cite a number of 400 cc.

You have to know that there is no science behind this regulation.

Studies have shown that even 200g reductions are beneficial and decrease shoulder and back pain.

There is a large body of literature supporting this issue.

Your surgeon should be able to fight with the insurance companies on your behalf if less than 400 grams of reduction on each side is required.

Good luck 

David Evdokimow, MD
Morristown Plastic Surgeon
5.0 out of 5 stars 10 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.