Ask a doctor

Breast Reduction - How Do I Proceed? What to Ask? How to Find the Right Doc?

Hello! I am 5'3", 37 years old and a mother to two teens. I have lost 50 pounds and am working on another fifty to get me to my goal weight of 140 (I am muscular, lower than 140lbs and I am too thin). Right now, I am wearing a 38I cup. Yes, I said "I" cup. It hurts. My breasts have NOT decreased in size with weight loss, and they are pendulous. Insurance is a problem even though I am being treated for back/shoulder pain, and have had surgery on both arms now. How do I get started? Thanks!

Doctor Answers (12)

Insurance coverage for breast reduction

+3

The most common complaints that I hear from patients desiring breast reduction are:

  • Chronic neck, back and shoulder pain
  • Poor posture
  • Bra strap grooving
  • chronic intertrigo under the breasts

Insurance coverage varies from patient to patient. Some companies require evidence of failed conservative therapy, some require a specific amount of tissue removal based on a patients BMI, some don't cover the procedure at all. A letter from your surgeon to the your insurance company requesting coverage should give you the information you need.


Columbus Plastic Surgeon
4.5 out of 5 stars 11 reviews

Planning for breast reduction

+2

Breast reduction is a common operation with high patient satisfaction.  It is the only known effecive treatment for severe breast enlargement (hypertrophy) with the symptoms you describe. Symptomatic macromastia is the most descriptive term.  The information you convey contains many issues that bear careful consideration and discussion.  If indeed you believe that an additional 50 pounds of weight loss is attainable and sustainable then it would likely be wise to wait until you have achieved that 140lb target weight that would serve as your new baseline.  If you were to have surgery at your current weight and then lose those 50 pounds, your result, just like the rest of your soft tissues, would change dramatically.  If, on the other hand, you find that your current weight is at or near your true baseline weight, then you may consider a surgery now.  The best way to make this determination is to have a consultation with a board certified plastic surgeon and review your plans for behavior modification and diet in the future.  It is important to understand that both weight gain and significant weight loss can impair the quality of your result.

Richard J. Wassermann, MD, MPH
Columbia Plastic Surgeon
4.5 out of 5 stars 11 reviews

Breast Reduction and Insurance

+2

First off, congratulations on your weight loss! I would suggest that you get within 10 pounds of your ideal weight before proceeding any further. Check your insurance policy to make sure that breast reduction coverage is even offered. Many insurance plans now list breast reduction as an exclusion which means they will not pay for this procedure. You can review your plan book or contact your insurance company.  Your board certified plastic surgeon's office staff should be able to assist you with insurance  pre-certification. We have our patients complete a questionnaire which includes the type of conservative therapy used prior to seeking the advice of a surgeon (wide strapped bras, chiropractic care, Advil, Aleve, etc). We also ask our patient to obtain a letter of medical necessity from heir OB/GYN or Primary Care Physician.  Your plastic surgeon will take photos from the neck down to send along with the above mentioned documents. Next is the waiting game with the insurance company,. It can take 3-6 weeks for a determination. Also ask your plastic surgeon's office about the appeal process in the event that you are denied coverage. Best wishes!

Christine Sullivan, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 19 reviews

You might also like...

Breast reduction insurance coverage.

+2


Insurance Coverage for Breast Reduction
 

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2) Very big reductions (like from an F cup to a C cup) will usually be covered.

3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7) Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9) Don't give up. If the first request is denied, demand an appeal.

10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.
 

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast Reduction and Insurance Coverage?

+1

Thank you for the question.  

It sounds like you are dealing with breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for the frame causing  both physical and psychological distress.  Please make sure you do your homework and understand the potential risk and complications associated with breast reduction surgery, including  abnormal scarring. You should also understand that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

Timing of the breast reduction surgery is  based on  the patient's psychosocial place in life and is a very individual- specific decision.  She must be able to accept the scars (which result from the breast reduction surgery)  in exchange for the improvement in size/contour/position of  the breasts.  Some patients choose to have the breast reduction surgery earlier in life; some patients prefer to wait until they are in mature/stable relationships and/or have completed  having pregnancies.

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. Make sure you're consulting with a well-trained/experienced board-certified plastic surgeon.  

Congratulations on your decision to pursue  breast reduction surgery; it is one of the most patient pleasing operations you perform.

Best wishes.

 

 

 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 751 reviews

The Issue of Insurance Coverage for Breast Reduction Surgery

+1

Check with your insurance company and find out specifically what they require to cover a breast reduction. Some companies want documentation that you have been treated for neck and shoulder pain either by a neurologist, or orthopedist. Some companies require a trial of physical therapy before they will agree to certify surgery. Documentation is important so get whoever operated on your arms to give you a letter. When you have your plastic surgery consult, pictures of your breasts and shoulders will be taken and sent with your pre-certification letter. Generally if you have good documentation and your pictures show large beasts, then coverage will be provided.

Carlin Vickery, MD
New York Plastic Surgeon
5.0 out of 5 stars 5 reviews

Breast reduction and insurance coverage.

+1

As you continue to lose weight, you can begin gathering infomation so everything is ready when you get to the weight you are trying to acheive.  First, find several board certified plastic surgeons you can consult with.  Contact The American Society of Plastic Surgeons for a list of surgeons in your area.  Once you have met with and found the surgeon you are comfortable with, they should be able to help you navigate the insurance coverage, depending on your insurance.  Reductions patients are some of the most happy patients so it should be well worth it.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 34 reviews

Breast Reduction - How Do I Find a Plastic Surgeon

+1

Hi redtailgal in statesville, NC,

Excellent question.

I usually recommend the following:

1)  Contact your primary care physician to see if he or she knows any plastic surgeons in your community.  No use in reinventing the wheel if someone near you has already done the research.

2)  Do the research.  Go online and do some basic reading about this procedure.  It's in your best interest to do the work ahead of time so that you and your surgeon can have a more knowledgeable conversation, rather than using that as your teaching time.

3) go to surgery dot org to find a list of surgeons near you

4) go visit at least 2-3 of them.  Do your research first, look at their websites to get an idea of what their practice is like

5) to the extent that cost is an issue, see which doctors accept your insurance.  You can start or limit your research to those doctors, depending on whether or not that is otherwise an appropriate thing to do.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 151 reviews

Breast Reduction

+1

Back and neck pain is one of the most common reasons for a person to have a breast reduction. Reducing the size of your breasts can definitely relieve a lot of this pain. The first thing you need to do is find a surgeon in your area that  accepts insurance, some Plastic Surgeons do not. After you have found a few near you, interview them.  This is really a consultation but you are finding out if they are the best fit for you! At your consultation make sure to see their before an after picture gallery. Doing this will give you an idea of their work and results. Good Luck!

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 30 reviews

Breast reduction starts with insurance predetermination

+1

One of the best ways to find a surgeon for breast reduction is a search through your insurance plan list of doctors within your plan. Reduction is a covered benefit for some companies, and an I-cup is sure to be within range of covered benefits. The plastic surgeon can discuss options after examination and begin an insurance predetermination to confirm benefits.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 29 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.