What Do You Do when You Dont Know if You Can Afford Breast Reduction Surgery but Feel You Need It? (photo)

I am 21 and i am 5'3 and about 160 to 175lbs an is has a somewhat tiny figure and have not yet had children. I have upper back pain an sagging with my breast. I am a 34O in bra size and have been sized with professional's more than once. I dont know if insurance will cover it and if they only cover some i dont know whether I will be able to afford the rest!!

added photo 2/15/12

Doctor Answers (10)

Breast reduction surgery

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Your first step should be to visit with a Board Certified plastic surgeon for an evaluation.  Many insurance companies do cover breast reduction, but have different criteria that must be met in order to get approval.  You may want to contact your insurance company directly to see if it is a covered benefit by your policy. Good luck.


Katy Plastic Surgeon
5.0 out of 5 stars 9 reviews

If you need it, you will find a way

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If you are 5'3 and weigh 160 lbs, your body surface area is 1.79 meters squared.  If you had Aetna insurance, they would require 645 gram removal.  Size 34 corresponds to 200 grams per cup size reduction.  If you are a size O then you would be a size L.  If you want more than that removed, it could be done also.  Insurance companies base coverage on symptoms which you have and weight removal.  You should definately meet the criteria.  You may have a deductible and have to pay out of pocket.  The goal of breast reduction surgery is to achieve attractive breasts and relieve pain.

Best of Luck,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 126 reviews

Paying for breast reduction

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1. See a plastic surgeon and see if your insurance will cover a breast reduction for you

2. If they do not cover, negotiate a price with the plastic surgeon(you can check with other plastic surgeons also)

3. Save your money and get it done. You will not regret it.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 17 reviews

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Breast reduction

+1

You should be examined by a board certified Plastic Surgeon.  The surgeon can evaluate whether you are a good candidate for breast reduction and help you obtain pre-authorization from your insurance company. The amount of  of  money you will be out of pocket can also be estimated based on your benefits , deductible, and maximum out of pocket. The first step is to see a Plastic Surgeon and start the pre-authorization process. Good luck.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 11 reviews

Insurance coverage for breast reduction

+1

Policies vary significantly among insurance companies; however many, if not most, will cover a reduction if it is medically necessary which means if you are having symptoms like back or shoulder pain or shoulder grooving. Most plastic surgeons who perform this surgery will be able to work with you to determine what your insurance will cover. So your best bet is to find a board certified plastic surgeon in your area and schedule a consultation. Good luck to you.
 

Margaret Skiles, MD
Sacramento Plastic Surgeon
3.5 out of 5 stars 10 reviews

Breast reduction and cost

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Without going for a consutlation, you wil not know the possible anser to your question.  Each insurance company is a bit different and it is hard to tell without an exam and discussion of your goals. The first step may be to call your insurance company and ask their criteria for payment.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Breast reduction and insurance.

+1

At my Austin, Texas area plastic surgery practice I can usually get most patients approved for breast reduction surgery if their plan doesn’t have a specific clause precluding this surgery as a benefit.  I would start by calling your insurance provider and find out if this is covered benefit.  Then ask what your deductible is and how much you are responsible for after the deductible is met.  Plans vary widely, I have had patients have no out of pocket and have had patients have more than 5K out of pocket.  Then ask your insurance provider for a list of board certified plastic surgeons in your area who are in-network with your plan.  Hope that helps.  Dr. Kerr.

Mahlon Kerr, MD, FACS
Austin Plastic Surgeon
5.0 out of 5 stars 85 reviews

Breast Reduction

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First off, I think you would be thrilled with the results of a breast reduction. At your age you do have to understand that the scars are permanent and the surgery could possibly interfere with breast feeding. See a surgeon and have his office preauthorize the surgery for you with your insurance carrier. I have, over the years, found that more and more patients are denied as the insurance companies limit coverage. Probably 30-40% of my patients are declined by their carrier. We have developed "Cosmetic Fees" that are affordable for patients that are told by the insurance company that, by their standards, the patient does not need surgery. So get a consult or two and you may find it is more affordable than you think.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 13 reviews

Will Insurance cover my Breast Reduction?

+1

From the dimensions of your breasts and the limitations and symptoms they impose on you it is reasonable to assume that your insurance would cover your breast reduction procedure. However, that is not how insurance works. Each insurance plan has a "menu" of covered and uncovered services. The plans that have the most covered "benefits" also cost the most. So having "insurance" does not mean you have great medical insurance. Your plan may or may not have breast reduction benefits. If it does not, it makes no difference if you have huge painful breasts which would benefit from a breast reduction. Since you / your employer did not pay to have breast reduction benefits, your insurance company will not pay for such surgery regardless of its potential benefit to you. 

You can look at your policy book and see if you have breast reduction benefits. If you do pick a Plastic surgeon who accepts your plan and see him. He/she will advise you on your options.

Good Luck.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 61 reviews

Breast Reduction and Insurance Coverage?

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Thank you for the question.

It sounds like you may need to do some more research into your specific situation. You may want to start with a consultation with a well experienced board-certified plastic surgeon  and a conversation with your insurance company.

The plastic surgeon will be able to inform you if you are a good candidate for breast reduction surgery and submit paperwork to the insurance company on your behalf. Your communication with the insurance company will provide you with information about  your policy and "coverage" of the breast reduction procedure.  You will be able to ask specific questions in regards to  your “share of costs” (if any).

I think once you have done these two things you will have most of your questions answered  precisely.

I would suggest that you  remain persistent;  breast reduction surgery is generally one of the most patient pleasing operations performed.

Best wishes.

 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 751 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.