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Do I qualify for a breast reduction possibly with insurance?

I'm 18 years old. 5'6 and 118 pounds with 34 DD. My left breast is much larger than my right, I would say it's DDD. People tell me that my upper body is "tiny" (except for my breasts). My lower body is regular sized. I have lost 5-10 pounds this year and I feel like my breasts have actually gotten larger. The problems I have been having is that I feel like my chest is heavy all of the time and my back feels strained. I feel like my breasts are weighing down on me and I'm in constant discomfort.

Doctor Answers (9)

Insurance

+1

Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.

Best wishes,

Dr. Basu
Houston, TX


Houston Plastic Surgeon
4.5 out of 5 stars 117 reviews

Breast Reduction Can Be Covered by Insurance

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Symptomatic macromastia (large breasts causing discomfort) is a very common issue. Breast reduction surgery can be covered under insurance if you qualify. You would need to be seen for a consultation to document your symptoms. This information
(along with photos) would then be submitted to your insurance to see if it is
covered.

I would encourage you to come for a consultation and one of our plastic surgeons can give you a better idea about the surgery, including the recovery time after breast reduction surgery. We can then submit to your insurance company.

Mitchell F. Grasseschi, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 3 reviews

Avoid vertical scars of traditional lifts

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At size 34 DD each 100 grams reduction corresponds to 1 cup size change. If your insurance company required 500 grams removal that would take you down 5 cup sizes to approximately size A. The insurance companies require large removal based on the premise that weight removal eliminates pain. There is a new technique called The Ultimate Breast ReductionTM. This technique transfers the weight of the breast to the underlying muscle resulting in immediate pain relief without excessive reduction. This technique maintains nipple sensation, the ability of breast feed and avoids the ugly vertical scars of the traditional technique. Since you are young these factors are important.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 125 reviews

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Do I Qualify For Insurance Coverage For Breast Reduction Surgery?

+1

Yes, Insurance will cover a breast reduction procedure if the following criteria are met.

  1. Amount of Tissue to be removed relative to height and weight (most patients go from a D or DD cup to a C cup)
  2. History of symptoms caused by condition:
    1. back problems 2.neck strain 3. bra strap irritation 4. rashes beneath breast
  3. History of trying to improve symptoms with conservative methods:
    1. Physical therapy, oral medication, massage etc.
  4. A letter is then sent for prior authorization by your physician.
  5. Because of your asymmetry, the doctor will plan on removing more tissue from your larger breast in an attempt to achieve better symmetry.

Would suggest that you consult with a board certified plastic surgeon and he will be able to give you direction. Also, a link is provided below with more information. Good Luck

Joseph Rucker, MD, FACS
Eau Claire Plastic Surgeon
3.5 out of 5 stars 4 reviews

Do I qualify for a breast reduction possibly with insurance?

+1

Based on your description you may be a good candidate for breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.

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 are working with a well-trained/experienced board-certified plastic surgeon.

Good luck; prepare to be persistent when dealing with health insurance companies.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 727 reviews

Breast Reduction and Insurance

+1

It is very possible that you may qualify for breast reduction under your insurance. It will depend on your insurance as each company has their own guidelines. Most require that 500 grams of breast tissue needs to be removed, and that is usually the equivalent of a DD cup size. See a Board Certified Plastic Surgeon that specializes in breast surgery to help you obtain authorization. If you should get denied, ask your surgeon to appeal, I have gotten several patients approved this way. Good luck!

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

Breast reduction using insurance

+1

Most insurance companies use the weight of breast tissue removed as the main criterion for insurance coverage. If you're not removing much tissue weight, they figure that it's really just a lift that won't improve your function or symptoms much. A board-certified plastic surgeon can evaluate you, estimate how much might be removed, and submit a precertification letter to your insurance carrier. If you have any documentation of symptoms like back strain, such as prior notes from your regular doctor, that may help too.

Andres Taleisnik, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 14 reviews

Insurance for breast reduction

+1

You may be covered by insurance as your BMI will be low. A minimum of 500 grams per breast must be resected for most insurance coverage. In NY, the carriers require at least six months of physical therapy or chiropractic, spinal xrays, orthopedic consultation, etc. See a board certified plastic surgeon who will be able to provide strategic assistance in jumping through these hoops!

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 11 reviews

Do I qualify for a breast reduction possibly with insurance?

+1

Yes, you may qualify for a breast reduction with insurance coverage. Check with your insurance company and then see a Board Certified plastic surgeon for an evaluation.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
5.0 out of 5 stars 18 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.