Which Insurance Covers Breast Reduction?

I'm 5'3 , and I'm 15 years old . My bust size is 34H . I'm not really overweight , but ive been really contemplating a breast reduction. I went to my doctor but he said my insurance doesn't typically cover that. I have constant headaches and backaches . And i just want to handle it before it really gets severe . I was wondering what insurance is best for this? Thanks (:

Doctor Answers (8)

Many insurance plans cover breast reductions for medical reasons.

+1

Almost all of my breast reduction patients with symptoms like yours were able to receive insurance coverage for their surgery. I would recommend consulting your parents and chosen surgeon for information regarding your insurance submission. Most insurance companies will cover a breast reduction when a patient is experiencing symptoms like yours. Although insurance companies all have different coverages and policies, it sounds like you would greatly benefit from a reduction. The best way to get started is to have your parents help you consult your insurance agent and ask your surgeon for assistance. Because you are 15, parental approval will be required for the surgery. I hope this information finds you well. 


Long Island Plastic Surgeon
5.0 out of 5 stars 2 reviews

Reduction requirement

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Insurance companies cover breast reductions based on two criteria.  One, you have to meet a minimum weight requirement for removal.  Second, you must have symptoms relating to the large breasts such as neck, back and shoulder pain.  At age 15, you would also require parental approval.  There is a new technique called The Ultimate Breast Reduction.  This technique reshapes your breast tissue creating upper pole fullness, elevates them higher on the chest wall and more medial to increase your cleavage.  This technique also relieves pain by transferring the weight of the breast to the underlying muscle.  This technique maintains nipple sensation and the ability to breast feed.  I recommend you avoid the Wise pattern (boat anchor shaped incision), which was developed in 1956.  This technique frequently results in nipple numbness, the inability to breast feed and breast drooping reoccurs. 

 

Best Wishes,

 

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 125 reviews

Insurance coverage for breast reduction is inconsistent.

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After your surgeon submits the criteria to the insurance company for breast reduction they will decide whether or not they want to pay for it. You can probably get a good idea your self by talking to your insurance agent.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 8 reviews

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Insurance coverage for breast reduction

+1

Many, if not most, insurance companies cover breast reduction if it is medically necessary. From your description of your symptoms, it sounds like you would qualify BUT every insurance company has their own criteria and even within a single insurance company, individual policies vary. You should talk with your parents and your doctor and find a board certified plastic surgeon who does accept insurance. A consultation with him or her would be the first step toward surgery. And he or she will help you find out if your insurance covers your surgery and any requirements they may have about how much tissue is removed. Good luck to you. This surgery is one that can make a huge difference in your life.

Margaret Skiles, MD
Sacramento Plastic Surgeon
3.5 out of 5 stars 10 reviews

Insurance coverage for a breast reduction.

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Hi SimoneDenae.  Insurance companies generally cover breast reductions when the patient meets their criteria of symtoms of macromastia which cannot be controlled conservatively. Conservative management generally means: Weight loss and being close to your ideal body weight, medications to treat aches and pains, and physical therapy to strenghten her core muscles.  It is also helpful to review the terms of your insurance contract. Some insurance contracts to exclude breast reductions. I suggest you see a plastic surgeon to discuss your symptoms, and see if a claim can be submitted.  Good luck!

Lewis Ladocsi, MD, FACS
Richmond Plastic Surgeon
5.0 out of 5 stars 24 reviews

Insurance for breast reductions

+1

I am not aware of any health insurance poilicy that globally does not cover breast reductions, but some are harder to work with for an authorization. Some require larger reduction amounts than others for a give height/ weight ratio (actually body surface area). 

Call you insurance company and ask if your policy covers breast reduction. If they say they do, I would suggest seeing another surgeon. 

Gordon Lewis, MD
Richmond Plastic Surgeon
5.0 out of 5 stars 8 reviews

Most insurance plans will cover breast reductions

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As long as you meet criteria for surgery your insurance policy should cover your reduction. Ask you parents to call your insurance company to find out what may be required for coverage. Thanks for your question.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

Which Insurance Covers Breast Reduction?

+1

Most insurance companies cover breast reduction, but it varies by area and state so you would need your parents to call around the local companies to get that answer.

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