Would I Qualify for Breast Reduction? Would Insurance Pay? (photo)

I am 18 years old, 5'11, 150 lbs, and I wear a 30K bra. I am in almost constant lower back pain, and have 2 bulging disks. I also have to have all of my shirts/dresses tailored for me, as nothing ever remotely fits properly!!! I thought exercising would help, but I walk, run and workout 1-2 hours a day, every day for over 3 years with very little relief. Being almost 6' is hard enough, so I would like at least some sort of normalcy...

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6 Doctor Answers | Asked by Jay from Upstate New York

Doctor Answers (6)
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Breast reduction

Although hour breast are ptotic, meaning they are sagging, they don't appear large enough to qualify for a breast reduction. they would more likely benefit for a breast lift, or a mastopexy. Although you suffer from back pain, it is does not appear that your breasts are contributing significantly to the problem. You should consult with a board certified plastic surgeon in your area for an evaluation for their professional opinion, since sometimes it is difficult to tell just... more

Your surgery would be considered a cosmetic mastopexy and not a reduction

You have breast ptosis (droop) without significant volume. This type of procedure you'd use is most acurately described as a breast lift (mastopexy) and would not be considered a medically necessary breast reduction procedure by insurance carriers.

Bresat reduction

It is tough to say bassed upon a photo, but from the photo they do not look that big. An in person exam may be different thana a photo. You s houdl check with your insurance company regarding their coverage policies.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Insurance Coverage

It depends on your insurance. There are many factors that go into coverage by insurance of a breast reduction. I have created a list of problems or information that insurance companies will need to see and/or review before approval 1. Insurance companies want to see a large breast size in relation to a patients weight. Another words if you are 120 lbs and have D cup breasts you are a good candidate. If you are 220 lbs and are only a D cup insurance approval will be less... more

Your breast reduction should be covered by insurance.

Hi. I hope this article is useful. 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... more

Breast Reduction Candidate?

Thank you for the question and picture. Based on your description and picture, it may very well be that your lower back pain is related to the “bulging disks” rather than the ptotic breasts. I would suggest that you be evaluated and treated for the possible spine issues first. Based on your picture, your breasts are topic ( drooping); at some point, you may benefit from breast reduction/breast lifting surgery. Although this may help you with issues... more