Could a Breast Reduction Help Me? Would Insurance Be Likely to Cover It? (photo)

I'm 21 years old, and I have horrible back pains every day of my life. I've been wearing a C cup but was recently sized as a 32DDD. I'm waiting for a new bra to be shipped to me in hopes for a little relief. I was put in physical therapy by my neurologist because she said I was developing a hump, and when I stopped the pain came back and was worse. I'm back in now and have a prescription to a muscle relaxant called chlorzoxazon. The pain is unbearable, and it makes my Narcolepsy worse. Recommendations?

Doctor Answers (9)

Insurance coverage for breast reduction

+1

Breast reduction may be covered by insurance if you meet certain critera, specified by your insurance coverage.  Often times, insurance company will need documentation of back pain, shoulder pain, photos, your height and weight, size of your breasts and proposed weight of breast tissue that would be removed.  If you do not meet the criteria set by your insurance coverage, you will need to undergo breast reduction by self-pay.  Your self-pay breast reduction cost will differ depending on your surgeon's fee, facility fee, and anesthesia fee.  There is a geographic difference as well.  It will vary from $8000-$10,000.  Please visit with board-certified plastic surgeons to discuss the overall cost as well as potential risks, alternatives, and benefits.  Good luck to you.


Houston Plastic Surgeon
4.5 out of 5 stars 36 reviews

Candidate for breast reduction?

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In order to obtain insurance coverage for breast reduction surgery, one must first demonstrate "medical necessity".  This usually means a history of musculoskeletal symptoms (shoulder pain/grooving, neck pain, back pain), no improvement with conservative treatment (such as physical therapy), hygiene problems (such as rashes in the crease underneath the breasts), and the proposed removal of a certain minimum amount of breast tissue (the amount varies from insurance plan to insurance plan). 

If you meet these criteria, and it sounds as if you do, then you may be a candidate for an insurance-covered breast reduction.  I suggest you see an experienced, board-certified plastic surgeon to be evaluated, discuss your options, and, possibly, submit a pre-authorization for sugery request to your medical insurance.

Robert Stroup, Jr., MD, FACS
Cleveland Plastic Surgeon
5.0 out of 5 stars 6 reviews

Breast Reduction Candidate?

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Thank you for the question and pictures.

Based on your description you may be a good candidate for breast reduction surgery; it is one of the most patient pleasing operations we perform.
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're saying a well-trained/experienced board-certified plastic surgeon.  

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 702 reviews

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Breast reduction candidate

+1

You may very well be a candidate for a breast reduction but an exam would be necessary so that a proper evaluation can be made.

Steven Wallach, MD
Manhattan Plastic Surgeon
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Breast reduction

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Your best bet is to see a board certified plastic surgeon for a consultation. They will advise you regarding the best way to approach your situation.

John P. Stratis, MD
Harrisburg Plastic Surgeon
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Breast Reduction and Liposuction

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Unfortunately it is impossible to evaluate your particular situation without medical quality photos, but from the symptoms you describe I would be quite surprised if you didn't see significant and lifelong relief with a reduction. The only way to find out about insurance is to see a well qualified board certified plastic surgeon and after the consultation his office will communicate with your insurance company and get that anwer for you.

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

Breast reduction

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Breast reduction would improve your back pain. See a board certified plastic surgeon in your area who can evaluate you and begin the insurance preauthorization process. Every insurance company has different standards and hoops that you haveto jump through. Best of luck!

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Could a Breast Reduction Help Me? Would Insurance Be Likely to Cover It?

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The photos do not show the breasts well enough. But you should set up an in person consult with a boarded PSs in your area to determine if the health insurgence would cover the surgery. I think yes but over the internet and with  poor representative photos hard to be sure. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Benefits of Breast Reduction

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Most women find breast reduction VERY beneficial in alleviating back pain, neck pain, shoulder grooves and rashes beneath their breasts. 

Additionally women remark at how confident they feel and happy that they can now wear stylish clothing, bathing suits and bras.

It seems as though you have taken the appropriate steps in seeking "conservative methods" to treat your symptoms.

Your next step would be to schedule a consultation appointment with a board certified plastic surgeon.  During your consultation, your physician will discuss your symptoms, conservative treatments that have failed you and the goal for your ideal breast size.  Additionally your physician will explain the procedure, ouline the location of the scars, discuss risks, complications as well as recovery. 

If your physician feels you are a good candidate for breast reduction surgery, a letter of predetermination will be written and sent to your insurance company along with photograhps for their evaluation.  Letters from your physical therapist recommending breast reduction surgery should be included. 

Richard A. D’Amico, MD, FACS
Englewood Plastic Surgeon
4.0 out of 5 stars 1 review

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.