What Happens if You Estimate More Tissue Removal Than You Can Take out in Surgery?

If you are still a DDD-F cup, I do not think your doctor will have difficulty reaching the 600 gram threshold. However, you raise a great question. Many insurance companies now require that we submit the post op pathology report which lists the gram weights. They have become wise to borderline cases and, especially when the patient begs to be a big C or small D cup and the plastic surgeon obliges, it can create a situation in which they will retroactively deny the case, sticking you with the full surgery, anesthesia and facility fee. In NY, GHI in particular is playing this game. I bring a scale into the OR and weigh the tissue during the operation and make it clear to patients that, if they want insurance to cover the procedure, the minimum gram weight must be removed. The alternative is paying for the surgery and not seeking insurance coverage. I think it is incumbent on us, as experienced plastic surgeons, to be extremely forthright about the insurance requirements, the expected result and whether the requirements and the patient's goals are aligned.

Short answer to your question is: yes, if the required amount of breast tissue is not removed, the insurance company can deny payment and you will be responsible for covering  expenses of all parties involved. Hope this helps.

Coverage will depend on your insurance's criteria. Most require a minimum of 500 grams to be removed from each breast. For most women that would be DD or larger. If it is less than that, they may not cover it. However if you are DDD or larger you should have no problem. But you should discuss this with your surgeon so you know where you stand. Good luck.