Breast Reduction: Q&A

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Would Insurance Cover My Breast Reduction?

I am a 23 year old female, i am 5'4 and weigh about 133 pounds.Before i got pregnant my breast size was a 34c. Then once i had my child and started breast feeding my breast grew to a very heavy 34DD. Even after i was done breast feeding and losing all my "baby weight" i still have 34DD breasts! And to top it off my left breast is significantly large than the right one! I have developed a horibble hunch back and have constant neck and shoulder pain.

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7 Doctor Answers | Asked by mickey23

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Body surface area determines reduction coverage

You are 5'4 and weigh 133 lbs, so your body surface area is 1.64 meters squared. If your insurance in with Aetna, they will require 495 grams removal. At size 34, each 100 cc's is 1 cup size change. You will have to go down 5 cup sizes to meet criteria that would end up a size A. It is most likely that your insurance company will not cover your breast reduction since you are only a 34 DD. They really do not care if you have neck, back or shoulder pain or... more

Breast reduction

Photos would help,a lot in evaluating your case. Insurance companies have certain criteria for covering breast reduction surgery, including symptoms as back, neck and shoulder pain. They almost always require a certain amount of breast tissue be removed from each breast, usually around 400 grams, or about a pound from each breast. You need to go through the pre-authorization process. this involves a consult with a plastic surgeon who will send a letter and photos to your... more

Breast Reduction Candidate?

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

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Will Insurance cover my Breast Reduction?

I encourage you to meet with a board certified plastic surgeon who accepts your insurance and see if he believes you are a good candidate, then you will have to submit his recommendations to your insurance company and see if they agree, it can be a very difficult process to gain approval , but I encourage you to try.

Insurance coverage for breast reduction

Each insurance company has it's own criteria so the first step would be for you to review these on the insurer's website. This will tell you what hoops you will have to jump through to get the procedure approved. Most insurance companies require proof that conservative medical measures did not improve your back pain, at a minimum.

Insurance Coverage For Breast Reduction

Although there is a lot of variance among onsurance companies regarding coverage of breast reduction, it sounds as if you should be covered, unless your policy has an outright denial for coverage. Obtain a consultation with a BC plastic surgeon who can communicate with your ins. co. for you.

Would Insurance Cover My Breast Reduction?

Medical insurance frequently covers breast reduction surgery, but depending on the carrier they will have several stipulations that need to be met, the most important is how much weight will be removed from each breast. They sometimes require notes from your primary care doctor that the excess breast weight is causing physical symptoms, and some require a trial of physical therapy. Understand, all these are time wasters because nothing short of surgery is going to relieve your symptoms. The... more

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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.

Breast Reduction: Q&A

Would Insurance Cover My Breast Reduction?