My Shoulders Constantly Dislocate and my Breast Are to Large For my Frame, Will Insurance Cover a Breast Reduction?

Hi, I'm 4'11 and I weigh 125 with a breast size of 36 DDD, this is quite painful on my lower back especially since I have an active lifestyle. Along with this, my shoulders have constantly dislocated since the 7th grade, this creates a constant tightness in my shoulders and upper back. I've had physical therapy and it didn't work, the doctors made me stop and they didn't want to do shoulder surgery. Should I do a breast reduction and would my insurance cover it?

Doctor Answers (4)

Candidate for Breast Reduction Surgery

+1

A more solid judgement can only be made through an in-person consultation with a board-certified plastic surgeon.  However, your description sounds like you are a good candidiate for a breast reduction.  While every insurance plan is different, we can work with you and your insurance company to medically justify this operation, and we have had good luck getting breast reductions covered by health insurance.  Sometimes this requires appointments with doctors to prove that your shoulder and back pain would be significantly reduced by surgically altering the size of your breasts.  Hope this helps and please don't hesitate to contact us with any questions.


New York Plastic Surgeon
5.0 out of 5 stars 17 reviews

Possible breast reduction?

+1

It is difficult to answer on words alone without photos, but your 4'11" frame with 125 lb and 36 DDD sounds like a great candidate for a breast reduction. Whether your insurance will cover or not is dependent on your particular policy and can be answered by a consultation with a reputable plastic surgeon and insurance predetermination. 

 

If insurance denies, you can still have the procedure at cosmetic rates as determined by your surgeon. This surgery will change your life and you will likely be happy should you chose to pursue it. Don't give up on your quest. Good luck. 

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast reduction

+1

TO determine if you are a good candidate for a breast reduction then you will have to go for a consultation.  As for insurance coverage, you should check with your insurance company to see what their criteria are for coverage.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

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Breast Reduction Candidate?

+1

Although it is not possible to give you personal/precise advice without direct examination and a full communication of your goals, based on your description it sounds like you may be an excellent candidate for breast reduction surgery. Your disproportionately large breasts seem to have caused significant physical ( and probably psychosocial) his distress.

The best way to obtain 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.

Be prepared to be persistent when dealing with health insurance companies; keep in mind that breast reduction surgery is one of the most patient pleasing operations we perform.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 780 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.