Would I Be A Good Candidate for a Breast Reduction and Will BCBS NJ Direct Cover?

I'm 5'4", 186 lbs, bra size 38 dd-ddd. Been dealing w/ back pain for approx 10yrs, it got worse after my 2nd child 5 yrs ago. I had a rash under my breast aprox 3yrs ago and finally complained to my gynecologist 3 wks ago at my yearly exam. He provided me with the names of 3 PS in the area. I went to an Ortho doc last week for back pain, he took xrays and said I have mild arthristis. He prescribed PT and samples of Celebrex and said I probably would benefit from a reduction.

Doctor Answers (3)

Breast Reduction Candidate?

+2

Thank you for the question. Based on your description, you may be an excellent candidate for breast reduction surgery.

Breast reduction surgery is one of the most patient pleasing operations we perform. By removing “excess” breast tissue, adipose tissue, and breast skin  this operation reduces and lifts the breasts to a higher position on the chest wall. By doing so, patients often find improvement in neck, back, and shoulder discomfort and find it easier to form their activities of daily living and exercise.

Timing of the operation will depend on the patient's life circumstances. In general, it is best to do this procedure ( like all other elective body contouring the stages,  when patients have reached their long-term stable weights.  In doing so, improve the safety of the procedure and minimizes the need for further surgery ( in the event of weight gain/loss after the breast reduction procedure).

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.  Prepare to be persistent when dealing with insurance companies and the authorization process.

Best wishes.


San Diego Plastic Surgeon
5.0 out of 5 stars 707 reviews

Insurance coverage and breast reduction

+2

Each insurance company is a bit different in regards to coverage for breast reduction.  It is est to investigate this.  If you like a specific doctor you can contact their office and they probably will help you find out.  Good luck.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 16 reviews

Will Insurance Cover Breast Reduction?

+2

Sounds like you may be a good candidate for a breast reduction. It is good to have a record of what physicians have recommended for you, and that you tried it without relief, such as physical therapy, good support bras, analgesics etc.Most insurance companies require that a minimum of 500 grams per breast needs to be removed. Usually that would be a DD or larger. The best way to find out if you would qualify is to see a Board Certified Plastic Surgeon who specializes in breast reduction surgery. Your surgeons office will know how to request authorization on your behalf. Good luck.

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 29 reviews

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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.