Breast Reduction: Q&A

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Will Insurance Pay for a 16 Yr Old with 42DD Breasts to Get a Reduction?

She is only 5'4 1/2" and weighs 160 (at least 20 lbs would be her breasts). She has not grown physically in the last two years more than 1/2", so her chest looks grossly out of proportion to her body. She also is developing a hunchback and pain in her shoulders. She's also cheerleading this year and they are seriously getting in the way. Also, is there a doctor at Children's Mercy in Kansas City you could recommend?

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12 Doctor Answers | Asked by D.C. in Leeton/Warrensburg, MO

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Breast Reduction for 16-year-old?

Thank you for the question. I'm glad to hear that your daughter has your support; this this will be very helpful to her. It sounds like she is dealing with juvenile breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for the frame causing both physical and psychological distress. As she thinks about breast reduction surgery make sure she does her homework... more

Breast reduction

Every insurance company has different requirement in order to cover breast reduction. E age could also be a factor. 16 is the youngest that i will perform a breast reduction.

VIDEO (Click here) Breast Reduction and insurance coverage.

It is best to go in for a consultation and have the surgeon draft a letter of predetermination of benefits to your insurance carrier to help ascertain your level of coverage. see video

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Breast reduction coverage for a 16 year old

What insurance companies deem necessary for surgery is not always what we as plastic surgeons think is necessary. In all cases a consultation with a board certified plastic surgeon is required. The surgeon will then submit his or her recommendations to the insurance company. Many times supporting documentation is necessary to substantiate the medical reasons for the surgery to meet the insurance companies criteria.

Randy Proffitt, MD

3 reviews

Mobile Plastic Surgeon

Will health insurance cover breast reduction?

In your situation, probably yes, but the best way to find out is check the provisions of your policy (online or by phone), and visit her primary care physician for referral to a plastic surgeon.

Breast Reduction Covered by Insurance

Yes, sometimes insurance will cover these types of procedures depending on the Insurance company and the severity of the case. I would recommend contacting your insurance company to get their requirements, as they vary greatly between companies.

Breast reduction is medically necessary

Breast reduction, when medically necessary, is covered by most insurance plans. This will require you doctor to submit information, and even photos, to the insurance company to receive a pre-determination of coverage. From your description, breast reduction may be medically necessary in this individual. I suggest you see two or three plastic surgeons for opinions.

Breast reduction

It is certainly possible that your daughter may be a candidate for a breast reduction. But without seeing her it is impossible to say. You can check with your insurance company regarding coverage.

Steven Wallach, MD

13 reviews

Manhattan Plastic Surgeon

Macromastia in Teenager

It is possible to have a Breast Reduction under your insurance if you have back pain, neck pain, inability to exercise and other symptoms related to the large breasts. You would need to check with your insurance company and go to a Plastic Surgeon as listed on your plan.

Juvenile Breast Hypertrophy

Macromastia in teenagers is also known as Juvenile Breast Hypertrophy. Breast reduction for this condition is indicated and is almost always covered under most insurance plans. My insurance authorization team has been very successful getting these types of operations covered. This can always be determined prior to surgery by contacting your insurance company.

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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.

Breast Reduction: Q&A