Would Insurance Cover Breast Lift to Relieve Pinched Nerve on Shoulder?

My breasts are heavy and I wear tight bra straps 24/7 for support or else I have shooting pain down down the outer side of each breast. I have shooting pain/painful itching sensation toward the outer part of my shoulder and up the right side of my neck.

Initially, I used slip on strap pads, then was given a Rx strength hydocortisone cream Nexttreated for shingles. The pain has not responded to anything. The Dr. suspects pinched nerve on my right shoulder.

Will insurance cover Breast lift to provide some relief in the right shoulder area where I have to wear the strap so tightly?

Doctor Answers (7)

Insurance coverage for breast lift (mastopexy) vs breast reduction surgery

+2

Important issues as to whether insurance would cover surgery for your condition include whether you need a breast lift or breast reduction. You didn’t mention the size of your breasts but you did say they are heavy. It may be that the favored procedure would be a breast reduction. If the symptoms are well documented, a causal relationship has been demonstrated, and other conservative forms of treatment have proven unsuccessful than most insurance companies will cover a breast reduction procedure. Obtaining insurance coverage for a breast lift is more problematic because it may be difficult to establish a causal relationship between the sagging or ptosis of your breasts and the symptoms. It would be hard to justify a surgical procedure if we could not confidently predict a successful outcome.

To receive a more definitive answer to your question, I would recommend a consultation with a board certified plastic surgeon. If the surgeon believes that the surgery is necessary, he may be able to submit a preauthorization request to your insurance carrier to obtain this information.

I hope this information is helpful. Good luck and I hope you can obtain relief from your symptoms.


Sacramento Plastic Surgeon
5.0 out of 5 stars 15 reviews

Breast Lifting and Insurance Coverage?

+1

Thank you for the question.

If your symptoms can be achieved it to hypermastia ( large breasts) then there is a chance that the insurance company makeup or breast reduction surgery. Most insurance companies require a certain weight to  be removed as part of their “authorization”.

Obtaining 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.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 707 reviews

Breast lift coverage for symptomatic issues

+1
Insurance companies will attribute your neurological symptoms to macromastia and approve a breast reduction if you can corroborate failure of conservative methods to treat the back or nerve pain. However, without removal of sufficient tissue to qualify as a reduction, insurance would not pay for a mastopexy. You need to consider whether you would be happy reducing enough tissue for insurance coverage or if you want to maintain a larger size and pay for the procedure out of pocket.

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

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Breast lift coverage

+1

If you have very large breasts and require a reduction, then perhaps insurance will cover it for you, but not for a "straight" lift.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 16 reviews

Insurance coverage for breast lift or breast reduction.

+1

Insurance Coverage for Breast Reduction

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2) Very big reductions (like from an F cup to a C cup) will usually be covered.

3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7) Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9) Don't give up. If the first request is denied, demand an appeal.

10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Lack of insurance coverage for breast lift

+1

Breast lift is a cosmetic procedure which insurance does not cover. I recommend all our patients be realistic with what insurance will cover and save or finance for their cosmetic procedure

Steven Yarinsky, MD
Albany Plastic Surgeon
4.0 out of 5 stars 5 reviews

Insurance coverage for breast surgery

+1

Insurance companies will often cover the cost of a breast reduction. A pure breast lift (which involves removing excess breast skin and a small amount of breast tissue) is not covered as it is considered purely cosmetic. A breast reduction which involves removing excess skin and a significant amount of breast tissue (close to a minimum of one pound per breast) may be covered by certain insurance carriers. The particular symptoms associated with macromastia (very enlarged breasts) are neck, shoulder, and back strain and irritated skin in the folds under the breasts. The symptoms that you are asking about in your question may not improve at all after a breast reduction and the exact cause should be further investigated by your doctor. If reducing the weight of the breast and the tight bra strap that is required to support your breasts will decrease your discomfort, then the surgery may be helpful. The best course of action is to see a board certified plastic surgery for a consultation.

Dr. Sean Simon

Sean A. Simon, MD
Miami Plastic Surgeon
4.0 out of 5 stars 27 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.