My Dr. Ordered 800 CC/breast. My Insurance Said It Needs to Be 1800. Is That Risky?

I am heavy )5'5", 240 lbs. Could that be the reasoning behind the doubled request?

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12 Doctor Answers | Asked by JRich in Jax in Jacksonville, FL

Doctor Answers (12)
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1800 sounds incorrect

As the other surgeons have mentioned, in order for a breast reduction to be "medically necessary," it must meet certain criteria. For the amount that is required by your height and weight, you are looking at somewhere between 900-950 gms per breast in order to meet at the 22nd percentile, which is what most insurance companies require. 1800gms might be your individualy carrier's criteria. This is could also be both breasts, which is fairly close. I would contact... more

Breast reduction?

Without an exam, I could not assess an approximate weight that might be removed during a breast reduction.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast reduction

Sounds like you are talking about breast reduction surgery, if so the amount to be removed is measured in grams not CCs. Each insurance company has its own criteria for height and weight and it looks like the 1800 grams are what they expect removed from both breasts in total and not from each breast. Hope that helps.

Insurance Reduction Requirements Do Relate To Weight

Almost all insurance companies do relate the amount of breast tissue removed to the patient's BSA (which tends to penalize women who are taller). 1800 grams of tissue does seem excessive if it is expected from one breast. If this represents the total weight from both breasts, it probably is accurate.

You can calculate your requirements for breast reduction if you have internet access.

Most insurance companies abide by the Schnur Scale. Use an online calculator to determine your body surface area in meters squared and then go to the following web reference to determine the amount of breast tissue removal that is required for you. Then, call your insurance company to see if they use the Schnur Scale as well. I hope this helps.

Breast reduction

1800 grams per breast is a very large reduction. If the insurance company is calculating the minimum that it will allow for your height and weight, that is possible, although I have never seen an insurer express it in those terms. They either approve or deny the reduction. Plastic surgeons do not "order" a set number of grams per breast. They estimate how much they intend to remove during the procedure and the insurer responds. I agree with other... more

Breast Reduction

If you are talking about breast reduction and grams (not ccs) to be removed, here are my thoughts.You need to get better communication with your surgeon. I bet he preauthorized 800gm per side and the insurance company wants 1800gm total. If so, you're close to covered. But few of us will remove breast tissue until we meet the insurance company's "requirements" because to do so may create a very deformed breast. So better get this cleared up.

1800 cc breast implants

You miss-understood. There are no 1800 cc breast implants made in the USA. Larger sizes are made in Europe. Risk is not more if done by an expert in stages. You can't go from zero to 1800 cc in one step. It takes expanders first and a remove & replace later. You should be the one to decide the size you want to be, not the doctor. We help our patients make that decision with several different methods. Dr Foster

Breast reduction requirements

1800 seems a little high. Check back with your plastic surgeon and bring your insurance information to verify the amount.

Breast reduction

I think there is some miscommunication. In order to cover breast reduction surgery all insurance companies require medical record documentation of symptoms caused by large breasts like shoulder pain, skin rashes etc and a variable period of a trial of conservative therapy like support bras. Most also require that a specific amount of tissue related to body surface area be removed in order to meet medically necessary non-cosmetic criteria. In your case that would be between 800 and 820cc... more