I'm 16, 5 feet tall, weigh about 140, am a DDD cup and wish to have a breast reduction. I meet all the requirements for a bilateral breast reduction except the age, but I'm fully developed and my breast/cup size hasn't changed for 3 years. My insurance claims I must be 18 to be "fully developed" but I am one of the exceptions to the development rule. Is there any way I can get around the age limit? If so, how? And if not, then what insurance does accept women under 18 for this procedure?
Why is the Age 18 for Breast Reductions for Women?
Doctor Answers (5)
Insurance coverage for breast reduction
Based on your measurements you seem to need a breast reduction. The insurance just places the restriction without any real medical substantiation. I have had many difficulties with my own patient getting coverage. The best way to get coverage is to call your insurance company...remember you are the consumer.
Age limits for breast reduction
There is no medical reason to wait until 18; it is your insurance that it imposing this limit. Your options are to change insurance companies, see a plastic surgeon who can appeal your case to your insurance and see if it can be approved, or to pay for it yourself. Good luck to you. It sounds like you are an excellent candidate for a reduction.
Breast reduction at 18 or older?
There is no specific age for you to wait to undergo a breast reduction. Your insurance has set its own terms. While it is not as common to treat teens, some fall into the category of needing it. I always like for my patients to wait until they have fully grown unless they have severe gigantomastia. Good luck.
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No Reason to Wait Until 18 Years Old for Breast Reduction
From a medical point of view, there is no reason to wait until a patient is 18 years old before having a breast reduction. The patient's symptoms, activity limitations and breast growth are the main factors. However, insurance plans have their own policies.
Your options are to ask for an appeal from your insurance company with review by a plastic surgeon, find another insurance plan, or pay for it outside of insurance.
Breast Reduction and Insurance Coverage and Age Requirement?
I'm sorry to hear about the difficulty you have experienced with your health insurance and coverage for the breast reduction procedure. I think your best bet is to have your primary care physician and plastic surgeon help you with letters of appeal. They may be able to help you express the issues just like you have done nicely in the question posted.
Unfortunately, you may find that you will meet with significant resistance from the health insurance companies even though the operation may be completely indicated. If this is the case, you may be faced with the decision to wait until you are 18 or save and have the procedure done fee-for-service prior to that time.
As you think about breast reduction surgery make sure you do your homework and understand the potential risks and complications associated with the procedure. Unsatisfactory scarring is one of the potential complications. Make sure you also understands 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).
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