Breast Reduction and Insurance? Age 24, DDD to C cup, BCBS Cover?

I am 24 years old and interested in a breast reduction. I am currently a 36DDD and looking to reduce to a 36C. I have suffered back and neck pain for years and have seen a chiropractor but it isn't helping. Do you think my insurance (bluecross blue shield) would cover the procedure? Do you think I am too young for the procedure? thank you

Doctor Answers (8)

Insurance Criteria for Breast Reduction

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From your description it seems as if you are a good candidate for breast reduction. Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses


Orange County Plastic Surgeon
5.0 out of 5 stars 45 reviews

Breast reduction

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It sounds like you  may be a good candidate for breast reduction.  24 is not too young for a breast reduction, I have performed them really in many different age groups and as young as 16 or 17.  Look for a board certified plastic surgeon to do your surgery is you are a candidate. Good luck.

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

Breast Reduction on insurance?

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Sorry to disappoint you but insurance companies have been allowed to defraud their clients. It's a total waste of time to even try to jump through their hoops. Get a piggy bank and when you've saved up $7172 you can have your reduction at my practice.

lawrence Foster, MD,FACS,FICS

Lawrence Foster, MD
Sacramento Plastic Surgeon
3.0 out of 5 stars 12 reviews

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Will my reduction be covered under my insurance?

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Difficult to say, you are certainly not to young. I would encourage you to visit with a board certified plastic surgeon to see if you are a candidate and if your policy will cover this procedure. Good luck!

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.5 out of 5 stars 16 reviews

Breast reduction coverage

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You are not too young for surgery and your breast size is within the insurance guidelines.  However, each insurer has additional criteria including BMI ratio and documented conservative medical management.  Consult your insurance handbook or speak to a board certified plastic surgeon to determine whether you will fulfill the criteria.  Some insurers require proof of 3-6 months of chiropractic, physical therapy, NSAIDs or other non-surgical treatment.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 11 reviews

Breast Reduction and Insurance?

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You are definitely not too young for the surgery. Almost all of my reduction patients that are in their 40's or 50's say they wish they had done the surgery earlier. The points I like to emphasize with my younger patients are that the scars are forever and it is always possible to loose nipple sensitivity and interfere with breast feeding. You have to weigh those negatives against the positive of a more comfortable life. In my state of Oregon, Blue Cross is pretty good about covering breast reductions, but it may be different where you live. Find a good plastic surgeon with lots of experience and get a consultation. His office will do the leg work for you in determining coverage.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 13 reviews

Insurance coverage for breast reduction

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Insurance will cover for breast reduction procedures but you have to meet their criteria. Typically this involves documentation of physical symptoms your having, non-surgical treatments that have been tried but not worked, documentation of rashes underneath your breasts that have not responded to medications, neck/shoulder/upper back pain that is unrelated to any other problems, the estimated amount of tissue being removed from each breast, shoulder grooving from your bra straps digging into your shoulders, your hight and weight, and sometimes x-ray documentation that you do not have underlying neck or back problems that could be causing your symptoms. Sometimes the approval process can take a while because it is a lot of back an forth with the insurance company and getting them the documentation they need.  Every insurance company has a slightly different criteria.

 

Based upon your description, I think they will likely cover your surgery. It is just a matter of providing them with the information they need.

You are not too young to have a breast reduction. Many women have this procedure when they are 17 or 18. If performed for the right indications, it changes their lives.

Perry Liu, MD
Beverly Hills Plastic Surgeon

Breast Reduction Timing and Insurance Coverage?

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Thank you for the question.

Unfortunate error is no good way of giving you accurate advice about your specific insurance company,  your specific policy, and/or coverage for the breast reduction surgery. You will be better off calling the insurance company directly.

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.

You are not too young to have the procedure done. As  you think  about  breast reduction surgery make sure you do your homework and understand the potential risks and complications associated with  the procedure.  Unsatisfactory scarring is  one of the potential complications. Make sure you also understands that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

On the other hand, breast reduction surgery is one of the most patient pleasing operations we perform and I think that for the right patient (enough symptoms) it may be an excellent option (regardless of the age).

Timing of the operation will depend on the patient's life circumstances. In general, it is best to do this procedure ( like all other elective body contouring the stages,  when patients have reached their long-term stable weights.  In doing so, improve the safety of the procedure and minimizes the need for further surgery ( in the event of weight gain/loss after the breast reduction procedure).
 


If at all possible, it is best to wait until after completing pregnancies before undergoing breast reduction surgery. Again, doing so will minimize the chances that patients will require further surgery after pregnancy related breast changes. Patients who seek breast reduction after pregnancy should wait at least 3 to 6 months after they have stopped breast-feeding and when they have reached their long stable weight.  

On the other hand, if patients are not planning on having children for several years, then breast reduction surgery may be indicated;  these patients will enjoy the benefits of a breast reduction surgery on a daily basis. However, these patients should also be aware that further surgery may be necessary after completion of pregnancies.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 722 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.