Breast Reduction: Q&A

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Breast Reduction Insurance Coverage

I am 37 years old from NJ, 5'3", weighing 140 lbs and wear a 36C. My breasts do not sag at all, yet. I have suffered from back problems for several years, but don't know if it is my breasts. I have always wanted to go to a B cup. Is there any possiblity that medicare would cover that? Also, does this type of breast reduction require the surgeon to remove and re-attach the nipple? Thank you.

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17 Doctor Answers | Asked by tracey01 in New Jersey

Doctor Answers (17)
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In my opinion, medicare would not likely cover this small of a breast reduction

I am from illinois and do not know if the Medicare administrator for your area is different than here. However, with most insurance companies you have the option of submitting a letter to predetermine your beneifts eligibility prior to surgery using photos, history, supporting letters, etc. This is not an option with Medicare. They will not respond to these types of letters in our area. Threrefore you have to undergo the surgery and submit the bills in order to determine if it is covered... more

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

You wouldn't qualify for a covered reduction

First of all, you are too small to qualify for a reduction. Most all coverages require at least 500 grams of weight (about a full pound!) of tissue to be removed from each breast to be considered "medically necessary." You certainly don't have that much. Secondly, it may be that your symptoms are from something else that a reduction wouldn't fix. Your doctor can check you for other causes of back pain. Finally, if you have good shape and skin tone and don't need lifting, you... more

Significant Breast Reduction required for Insurance coverage

Insurance Criteria for Breast Reduction Varies between Companies but going from a C to a B cup, I doubt any insurance policy would cover such a small amount being removed as it is unlikely to be the main source of your back pain. Insurance Criteria for approval for Breast Reduction varies from insurance company to insurance company. Contact your individual company and request their specific Criteria. Insurance company favors approval for patient with functional problems like the... more

Breast Reduction Surgery

Each insurance company is different with what they require to "authorize" the breast reduction surgery through insurance. In your case, it doesn't sound like insurance will cover the procedure because you are only reducing 1 cup size. For each case, I write a letter and send photos of the patient when trying to get authorization (I am sure most plastic surgeons do this as well). Also getting supporting letters from other doctors who can document that you have... more

Breast lift

Medicare will not cover a very small breast reduction.The back pain might be related to other issues. A breast lift could be the best procedure for you. Best of luck!

Will not be covered.

Hi, Thank you for your question! Medicare would not cover this because in order for a reduction to be medically necessary, you would need to have a significant amount removed, about at least a pound to be exact. Usually, a size DD or larger. Also, it doesn't sound like you would even be a good candidate for a reduction. You may want to look into liposuction for the breast as that would be best for minimal removal of tissue. You should consult a board-certified plastic surgeon in order to... more

Breast reduction and insurance coverage

As other doctors have stated, it is highly unlikely that an insurance company would cover the cost of your breast reduction. Depending on your geographic location, your body habitus, and your insurance company, your surgeon would likely be required to remove at least 400-500 grams of tissue. Starting as a C cup, that may make you smaller than a B cup when the operation is over, and it is very possible that the breast would have a flat, displeasing shape. If you still wish to be smaller, a... more

Insurance coverage of breast reduction operations

In general, insurance companies cover operations that are done to improve your health (not your looks or body proportions.) In relation to breast reductions, the indications for coverage are typically related to neck or back pain from the weight of the breast, or sometimes rashes due to moisture under the breasts. It is not uncommon for the insurance company to want 500gms removed from each breast as coverage criteria (if this much is removed, they can expect some change in the back pain... more

Small breast reductions

To go from a "C" to a "B" it is extremely unlikely that your insurance company will pay for your reduction. Such a small reduction may not improve your back symptoms at all. If the breasts do not sag at all it is unlikely that you would need movement of the nipple areola...

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Insurance does not pay for small breast reductions.

Hi! I am afraid no insurance plan will pay for a breast reduction that only takes you down one cup size. Also, it is not likely that your back pain is due to your breasts if you are only a C cup. The good news is that since you have no sagging, and you only want to go from a C cup to a B cup, you sound like an ideal candidate for liposuction only breast reduction. This procedure is essentially without scars, has an easy recovery, and also costs significantly less.

It all depends on your insurance

In many cases, health insurance companies will cover breast reduction surgery. However, they often require letters from your doctor and possibly your primary care physician as well. You also often need to have photographs done for their review. Additionally, the insurance companies often require a minimum amount of tissue to be removed, which can complicate the cosmetic outcome of the procedure if too much tissue has to be taken to meet insurance requirements. I hope this is helpful.... more

Breast reduction is sometimes covered by insurance.

You are 37 year old and to be eligible for Medicare coverage you need to be 65. Medicaid covers people who have an income below a certain level. What you describe is not covered by any insurance. Insurance co. have a weight scale table that they use to cover the breast reduction procedure. Based on your height and weight, your body surface area is 1.67 meter squared. This would require removal of 360grams of breast tissue per side. This much reduction is approx. 2 cup sizes, so you would... more

Sounds like you're not qualified for breast reduction insurance coverage

I agree with the above surgeon. Sounds like you do not meet the criteria for a breast reduction. See a Board Certified Plastic Surgeon. You need to remove at least 500 grams for approval to be covered and have documentation of symptoms of bilateral macromastia.

Medicare coverage

It does't sound like you are either a good candiate for reduction or that insurance will cover. However, if you want to go from a C to a B there are ways to minimize your costs - perhaps liposuction would work. See a qualified plastic surgeon.

Unlikely you need breast reduction

With the information you have provided it does not sound like you will benefit from a breast reduction. Granted - cup sizes are inaccurate. The best way to determine your needs is to consult with a board certified plastic surgeon to review your concerns and treatment options available. However, patients typically who pursue and will benefit from a breast reduction are D-cup or larger and have sagging to their breasts. Therefore, a smaller and better shaped breast has a significant positive... more

Will not cover

You do not have indications for the breast reduction. To qualify for the insurance to cover breast reduction you need to reduce the breast by at least 500 gram(1 pound) You have c size breast and your back pain may not be from your breast.

Kamran Khoobehi, MD

28 reviews

New Orleans Plastic Surgeon

Breast reduction and Insurance

With the size that you are describing it is unlikely that insurance will cover the breast reduction and I am not sure that this is the cause of your back pain anyway. It is true that back and neck pain can be a result of large breasts but yours appear to be minimally large for your height and weight. A mild breast reduction can be done that does not require removal and reattachment of the nipple and areola. There are different tecniques for breast reduction depending on the amount of... more