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Do You Think Tricare Prime Will Cover a Breast Reduction for Me?

I am 4 "10. I weigh about 118 lbs. my bra size is 34 DD. only because my right one is DD and left one is D.I've been 108 lbs with these boobs before. They never went down with my weight loss. I have back pain ESP on my right back side and lower back, so I suspect it's from my right boob weighing it down. My neck is also always very tense. My posture has been worse since I got these boobs and occasionally is catch myself and sit up straight. Will tricare prime cover breast reduction?

Doctor Answers (4)

Each Insurance Provider is Different

+1

Each insurance company has different criteria for determining whether they will cover breast reduction surgery.  You need to have a consultation with a plastic surgeon who will gather information such as your height, weight, breast measurement, photos and whether you have a history of neck and back pain.  The doctor will then submit that information to your insurance provider for pre-authorization.  If approved, your surgeon can schedule you for the procedure. Best of luck to you!


Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 7 reviews

That's up to the insurance company

+1

It is interesting that patients will come to this forum to ask this question.  In fact the place to start is with your insurance company (unfortunately).  Check to make sure your policy covers breast reduction as some may not and others require extensive documentation.  In order for your surgery to be covered you would need to reduce each breast about 275 gm according to a scale called the schnur scale.  This bases the amount to be reduced on a formula based upon height and weight.  See a board certified plastic surgeon to get his/her opinion before proceeding.  Good luck, Dr. Schuster in Boca Raton.

Steven Schuster, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 reviews

Breast Reduction and Insurance Coverage?

+1

Thank you for the question and pictures.

It certainly sounds like your breasts are too large for your frame  and causing you significant symptoms. You may be an excellent candidate for  breast reduction surgery to reduce and improve the symmetry of your breasts.

 Whether or not the specific insurance will cover the procedure can only be determined after your “case” is presented to the insurance company. Therefore, it will be necessary for you to meet with plastic surgeons who can submit your information to the insurance company.

As  you think  about  breast reduction surgery make sure you do your homework and understand the potential risks and complications associated with  the procedure.  Unsatisfactory scarring is  one of the potential complications. Make sure you also understand that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

 Most importantly, it will be important for you to select a board-certified plastic surgeon who can demonstrate significant experience achieving the types of outcome with breast surgery that you are pleased with.

 Best wishes.

 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 681 reviews

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Will Tricare Prime Cover Breast Reduction Surgery?

+1

The military has excellent insurance coverage. If it is determined that you have pain in your neck, shoulders and/or upper back due to large breasts it is possible your insurance may cover your surgery.Different insurance companies have different guidelines, I suggest you see a Board Certified Plastic Surgeon that specializes in breast surgery and have a pre-authorization request submitted on your behalf. Good luck!

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 28 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.