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Am I Eligible for a Breast Reduction?

I am 17, 5'2, 120lbs, and 34D. Am i eligible for a reduction? And can i get it covered by insurance? My back and neck are always sore not to mention headaches all the time. I wear baggy cloths a lot to try and cover the size of my breasts and swim suit shopping always ends in tears because of them. All i want is to be physically and emotionally happy, but its hard with my unproportioned body. Insurance is the only way possible for the surgery to happen if eligible.

Doctor Answers (15)

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 101 reviews

Breast Reduction for Teenager

+1

It sounds like you are dealing with juvenile 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.

It sounds like you have done your homework and understand the potential risk and consultations associated with breast reduction surgery. You also understand that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

On the other hand, breast reduction surgery is one of the most patient pleasing operations we perform and I think that for the right teenager (enough symptoms) it may be an excellent option (regardless of the age).

I would suggest an in-person consultation with a well-trained/experienced board-certified plastic surgeon. Best wishes.

Sep 10 '11, 11:33am

Web reference: http://www.poustiplasticsurgery.com/Procedures/procedure_breastreduction.htm

San Diego Plastic Surgeon
5.0 out of 5 stars 626 reviews

Insurance and Breast Reduction

+1

First find out if your insurance has an exclusion for breast reduction, unfortunately many do these days. Most that do cover the procedure require a minimum of 500 grams  to be removed from each breast. In most cases that would be a DD. However you are small in relation to your breasts, so as long as you have parental approval, you need to have a consultation with a Board Certified Plastic Surgeon who can help you seek pre authorization for your surgery. If you get turned down, don't give up, most insurance companies allow you to appeal their decision and your case will be reviewed by a medical doctor or surgeon who may even wish to speak to your surgeon. I have had many patients get approval on appeal. Good Luck!

Web reference: http://www.sanfranciscocosmetic-surgery.com/pro_breast_reduction.html

San Francisco Plastic Surgeon
4.5 out of 5 stars 24 reviews

Breast Reduction and Insurance Coverage

+1

Hi Kaley22121,

Each insurance company is different and, not surprisingly, it is become harder and harder to get insurance companies to pay for this procedure. In general, though, they will cover the procedure if you can show that removing the indicated amount of tissue (more on that below) will be likely to alleviate certain specific symptoms.

First, then, you have to have those symptoms. Typically they would include neck, back and shoulder pain, bra strap grooving and/or intertrigo (rashes underneath the breasts). The inability to exercise or to sleep comfortably can be additional symptoms.

Then, you have to have "enough" tissue removed. Understandably, if only a small amount of tissue is removed the insurance company is more likely to consider it a cosmetic procedure (called in that case a "breast lift" rather than a breast reduction). It used to be that a breast reduction would be more likely to be "covered" as long as 500 grams - a little over a pound - was removed from each breast. Now, though, it is typically more complicated. In general, you have to remove a certain amount of breast tissue relative to your body mass index. Here's a site that can help you determine your body mass index nhlbisupport.com/bmi/. Even then, though, you will have to find out from your insurance company how much tissue has to removed in order to qualify. Companies don't normally publicize their criteria widely, but they may and, in the meantime, this something that your plastic surgeon may be able to help you with.

So, if you put all of that together, I think that you probably will not qualify according to the usual criteria, but that if you can document the pain and discomfort you have along with the failure of medical/conservative therapy, you'd be much more likely to get it covered.  Either way, you'll have to work with a plastic surgeon on this, so you'll need to go see one or more until you find one you like, and then proceed with that one.

I hope that this helps, and good luck,

Dr. E

Web reference: http://www.bodysculpture.com

New York Plastic Surgeon
5.0 out of 5 stars 140 reviews

Questions regarding a breast reduction in a 17 year old

+1

You have several very good questions and concerns that need to be sorted out. First of all, being a minor at 17 you would need permission from your parent(s)/guardian to proceed with surgery.

You can be made smaller via a breast reduction. Whether it is "necessary" or will improve your appearance and self esteem is unclear. You must also consider the scars that would eventuate from the surgery and whether or not the trade off would be worth it.

Insurance coverage varies from plan to plan so it would have to be determined whether there is indeed coverage for breast reduction surgery and if so, if you could qualify.

A plastic surgeon can evaluate you in consultation including making recommendations for or against surgery. If he/she feels surgery is a reasonable option, he/she can either attempt to obtain insurance approval for you or state that you would not meet insurance qualifications for coverage.

Web reference: http://www.turkeltaub.com

Scottsdale Plastic Surgeon
5.0 out of 5 stars 20 reviews

Breast Reduction

+1

Because you are a minor, discuss your concerns with your parents. A consultation with a Board Certified Plastic Surgeon would be the first step in determining if you are a candidate for this procedure.  A letter from your Primary Care Physician will also be beneficial in obtaining approval. Insurance companies will also ask about conservative therapies such as losing weight (which you do not need to do), trying a wide strapped bra, etc. Your parents should also contact their Human Resources Department to determine  if Breast reduction Surgery is a covered benefit.  Best wishes!  

Columbus Plastic Surgeon
5.0 out of 5 stars 18 reviews

Will insurance cover my breast reduction?

+1

Kaley, you ask an excellent question.  I perform several breast reductions a month and have become quite dismayed at how insurance companies completely control the process.  The truth is that each insurance company has different criteria and some plas have exclusions.  Without consulting with a plastic surgeon and submitting to insurance for pre-determination, you may never know.  Good luck

Web reference: http://www.tarrantplasticsurgery.com

Dallas Plastic Surgeon
5.0 out of 5 stars 61 reviews

Breast reduction may be covered by insurance.

+1

This is a reasonable request.  The minimum age for surgery without a parent or guardian is 18.  Unless you are an emancipated minor.  You can get a letter of predetermination from your insurance company to see if the procedure may be covered.  In some cases and depending on the insurance company, they will cover it because it is causing you physical pain and distress.

Web reference: http://www.bodysculptor.com/breast-surgery-chicago/breast-reduction/

Chicago Plastic Surgeon
5.0 out of 5 stars 39 reviews

Eligible for breast reduction?

+1

From what you describe, you may benefit from a breast reduction and it may be covered by insurance. The next step would be to see a Bard Certified plastic surgeon for a consultation.

Web reference: http://DrGutowski.com

Columbus Plastic Surgeon
5.0 out of 5 stars 16 reviews

Breast Reduction Surgery Requires Predetermination Letter For Potential Insurance Coverage

+1

Insurance coverage for breast reduction requires a predetermination letter to be sent by your plastic surgeon with specific qualifying information. Your height, weight, breast cup size, history of medical symptoms associated with your large breasts, what non-surgical treatments have been attempted, and how much breast tissue in grams is to be removed is the needed information. This letter, complete with photographs of your breasts, will be submitted for their review. They will then determine if you qualify and their decision with be returned by letter to you in about 4 to 6 weeks after submission.

Web reference: http://www.eppleyplasticsurgery.com/breast-red.html

Indianapolis Plastic Surgeon
5.0 out of 5 stars 26 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.

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