Am I Candidate for a Breast Reduction Through Humana?

Question

I'm a 5'5 female, aged 16, size 48DD breasts and I weigh 190 pounds. I am unable to exercise with out feeling horrible pain in my boobs, my sitting and standing posture is horrendous. I suffer from back a shoulder pain as well as my bra straps indenting and marking my shoulders. My question is if my age would interfere with being a candidate for a breast reduction. For some background, I've always had boobs even when I was younger and slimmer. I have always had overly developed breasts.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question.  Certainly, given your age, you should discuss this with your parents first.  If you are experiencing difficulty with your activities or social issues, consideration for surgical intervention at your age for juvenile hypertrophy is warranted.  It is a safe procedure, in which your plastic surgeon will reduce the amount of breast tissue, reshape your breasts, raise the nipple-areolar complex to its appropriate position (possibly making the size smaller, if needed), and ultimately ameliorate the possible complaints that you do have for the reason that you are having this procedure (e.g., neck/back pain, migraines, rashes/infections, shoulder grooving, etc).It would be in your best interest to have a mammogram prior to the procedure for screening prior to this procedure, as the architecture imaging of your breast will slightly change afterwards. Well known data exists that having a breast reduction will in fact lower your chance for developing breast cancer, simply because the amount of tissue will be less.Consult with a board-certified plastic surgeon who will discuss the procedure with you, examine, and assist you in determining if this is the right procedure for you.  Voice your complaints - your insurance will likely require a detailed description of your history and complaints as well as photo and an estimate of how much tissue will be removed.  You should give a description of the therapies that you have done to ameliorate your complaints thus far.  Any other notes from other physicians is helpful.  It would also behoove you to discuss your issues yourself with your insurance carrier.  Hope that this helps!  Best wishes!

Vincent N. Zubowicz, MD · Answer

You probably will have to get prior approval through your plastic surgeon but you can contact your insurance carrier and see under what conditions breast reduction is covered.

Raj S. Ambay, MD · Answer

Reductions can be done as early as 15 with parental consent, and the proper medical clearances. Insurance coverage is a hit or miss depending on the carrier. Usually having symptoms related to breast size is necessary for insurance coverage. Getting it covered though is very difficult. Insurance companies wont tell anyone how much tissue needs to be removed to qualify for coverage. Then if the surgeon is 1gram off they deny coverage after the fact. Insurance companies make money by denying coverage. For that reason most plastic surgeon will likely ask for payment up front. Breast reductions are the most gratifying operations because years of neck, back and shoulder pain are gone within days. The final size result depends on your starting size. If you start larger then you will likely end larger. It is not possible to choose a size with any real accuracy. The main reason is that the procedure removes breast tissue but leaves enough tissue to preserve the blood supply to the nipple and areola. Thus more tissue needs to be left behind to ensure nipple viability. The nipple and areola is constantly being accessed during the operation.

Kevin Tehrani, MD, FACS · Answer

Your symptoms listed are common in breast reduction candidates and are after completely relieved after surgery. You should see a board certified plastic surgeon with your parent/guardian who will in turn discuss and apply for coverage with your insurance company.

Jeffrey Zwiren, MD · Answer

From your description you would be a good candidate for a breast reduction.  The next step is to see a plastic surgeon for an evaluation and pre-authorization.

Steven Wallach, MD · Answer

While it sounds like you may be a good candidate for a breast reduction, each insurance company has different criteria for coverage. Best to ask them.

Tom J. Pousti, MD · Answer

I'm sorry to hear about the physical and psychosocial problems your disproportionately large breasts are causing you.  It is probable that you are dealing with juvenile breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for your frame causing  both physical and psychological distress.

	It will be in your best interest, if at all possible, to achieve a long-term stable weight prior to proceeding with breast reduction surgery.

	
	In my practice, timing of breast reduction surgery is determined on a case-by-case basis. It is not too early to do your homework and learn as much as possible  about  breast reduction surgery and the potential risks and complications associated with  the procedure.  Hopefully you have the support of your parents as you do your homework.
	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 teenager (enough symptoms) it may be an excellent option (regardless of the age). 

	Sometimes breast  reduction surgery is covered through health insurance. 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.  When the time is right,  seek consultation with well-trained/experienced board-certified plastic surgeons.
	  I hope this helps.

George J. Beraka, MD (retired) · Answer

Hi,

	There is an article I wrote on my profile about insurance coverage for breast reduction.  You are probably eligible.

Am I Candidate for a Breast Reduction Through Humana?

Answers (8)

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