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I'm 40 DDD. I Didn't get Approve Me for a Breast Reduction, but They Did Approve Me for the Bilateral Mastopexy. Will This Help?

I am 26, 5 feet 2 inches and I weigh 168. Im currently wearing a 40 DDD ( im pretty sure I should ne wearing a bigger size), and I do suffer from ptosis, back and shoulder pain. Since my insurance has a exclusion for the breast reduction surgery and denied me, my doctor submitted one for the mastopexy. They approved me for that procedure, however, Im not sure how much this will help me. Whay should I do? See the attached letter sent from insurance.

Doctor Answers (5)

My Insurance Didnt Approve Me for a Breast Reduction, but They Did Approve Me for the Bilateral Mastopexy. Will This Help Me?

+1

If you want a breast reduction, I would have a breast reduction to help with your symptoms. Find a plastic surgeon with ELITE credentials who performs hundreds of breast reductions and breast lifts each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.


Kenneth Hughes, MD Los Angeles, CA


Los Angeles Plastic Surgeon
5.0 out of 5 stars 237 reviews

Insurance coverage for a mastopexy but not breast reduction is confusing.

+1

A mastopexy is an aesthetic procedure to reshaped the breasts. Sometimes the breasts are made smaller, breast reduction, and sometimes they are made bigger by breast augmentation or The same size. Only a breast reduction would be a functional operation.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 10 reviews

Insurance payments for breast surgery are insufficient

+1

I have never heard of an insurance company approving a bilateral mastopexy.  However, if they did you need to find out how much will pay to the surgeon.  With breast reductions, the surgeon usually gets paid less than $1,000 and for this reason surgeons refuse to do breast reductions for insurance only.  The same thing will be true for bilateral mastopexy if the payment is that low.  Your alternative is to pay for it yourself.

Best Wishes,

 

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 134 reviews

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Odd

+1

I have never had a patient get approval for a breast lift unless it was done as secondary procedure to address opposite breast issues in Breast Caner patients.  I would call your doctor back and ask him about that.  Mastopexy is a very similar operation...but done for cosmetic reasons. 

K. Dwayne Fulks, MD
Chattanooga Plastic Surgeon
5.0 out of 5 stars 1 review

My Insurance Didnt Approve Me for a Breast Reduction, but They Did Approve Me for the Bilateral Mastopexy

+1

This sounds quite peculiar. Most carriers (correctly) consider a mastopexy to be cosmetic and don't cover the procedure. I see a note that this may be covered, but they note there is no guarantee of payment, and this would worry me as a patient, as you could wind up with an enormous and unexpected bill. 

Best to discuss options with your surgeon. A lift alone will not reduce breast size or symptoms. A reduction includes a lift as a component of the procedure.

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 33 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.