Would I Qualify for a Reduction?

im 19, 5'5", 150lbs and am a 40DDD. ive been a DDD since i was 15. ive had serious neck, back, and chest pain for years. ive tried losing weight, dieting, everythign and nothings worked. I had humana before i got pregnant and my doctor said i would qualify but i switched to blue cross blue shield and i dont know what they will say. I cant take the pain anymore and would just like a pro opinion or guess at if i would qualify for a reduction with BCBS before i get my hopes up. Thanks!

Doctor Answers (10)

Breast reduction candidate

+1
You are definitely a candidate for a breast reduction operation.  To what extent your insurance company will help to pay for it is a different question.  Call your insurer to obtain the answers you need on your policy. Good luck.


Los Angeles Plastic Surgeon
5.0 out of 5 stars 16 reviews

Would I Qualify for a Reduction?

+1

First, your surgeon should write to your insurance carrier, sending along photos and documenting an estimate of how much breast and fatty tissue would be removed, as well as any supporting documentation about neck, back and shoulder pain and bra strap furrowing.  Your insurance carrier will then inform the surgeon if they will consider covering the procedure.  Some policies have exclusion clauses pertaining to breast reduction surgery. 

Jonathan Ross Berman, M.D. , F.A.C.S.

Jonathan Berman, MD
Palm Beach Plastic Surgeon
5.0 out of 5 stars 5 reviews

Breast reduction requirements

+1

At 5'5 and 150 lbs your body surface area is 1.76 meters squared.  Insurance companies vary but they base their approval on body surface area.  For example, if you had Aetna insurance they require 610 gram removal.  At a chest size of 40 inches, each cup size corresponds to 300 cc's and you would go down 2 cup sizes from a DDD to a D.  Insurance companies require symptoms of pain which you have described.  You will qualify, the only question is how much they will require you to have removed.  Breast reductions can be done with vertical scars but they widen and cannot be hidden.  There is a new procedure called The Ultimate Breast Reduction which can be done without vertical or boat anchor scars.  Also, this technique transfers the breast weight to the underlying muscles relieving pain.

Best of Luck,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 119 reviews

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Breast reduction

+1

It sounds like from your description that you are a candidate for a breast reduction.  The best way to say for sure is to go for a consultation

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Qualify for Breast Reduction?

+1

Thank you for the question.

Based on your description, sounds like you are an excellent candidate for breast reduction surgery.  It is one of the most patient pleasing operations we perform.

Unfortunately, it is not possible for online consultants to determine whether your insurance company will “cover” the procedure. The best place to start would be with visits to well experienced board-certified plastic surgeons who can document the symptoms the large breasts are causing  and  submit a letter to your insurance company on your behalf.

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;  although it may take significant effort to receive insurance company authorization,  the benefits of breast reduction surgery will be worth the effort.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 680 reviews

Breast Reduction Requires Insurance Pre-Determination Process

+1

No plastic surgeon or even a service representative from your insurance company can tell you whether you would or would not qualify for a breast reduction. This requires a pre-determination process which begins with a plastic surgeon consultation in which photos and measurements will be taken. This will then be submitted in writing to your insurance company from which they will make the decision about your eligibility.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 26 reviews

Breast reduction and insurance coverage

+1

Part of the qualification for breast reduction is quite specific such as presence of ulcers, dermatitis, and how much tissue is removed. Another justification is for pain relief. You can do a simple test to determine how much reduction will diminish pain symptoms. When you feel the discomfort in your neck, back, or shoulder, cradle your breasts in your arms and support them. Spend a bit of time sitting or walking around like this and see if your discomfort recedes. If you experience significant relief, chances are reduction will be beneficial.

 

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 7 reviews

Breast reduction insurance approval

+1

From looking at your photo and your description of symptoms it is very likely that you would qualify for a breast reduction.  Since you have switched insurance companies you will need to go through the entire approval process one more time.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 7 reviews

Breast reduction criteria

+1
In terms of heigth, weight and bra size, you should qualify but many insurers have requirements of conservative medical management. These should be available on your insurance company's website. Some nsurers require proof that you have tried physical therapy, chiropractic, orthopedic management, NSAIDs, etc. See a board certified plastic surgeon in consutlation who can obtain a full history from you and begin the authorization process.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Yes, you probably will qualify

+1

It is very likely you will qualify.  You meet the size and symptom criteria for surgery but sometimes they look at your weight as well.  You should visit your plastic surgeon and he will explain the process.

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.