Tips to Get your Insurance to Cover Breast Reduction


No matter the reason a woman decides to have plastic breast surgery, this decision may cause her stress: physically, emotionally and financially. Her stress can be lessened if she is presented with the right information, such as the symptoms that hint towards surgery, how she may obtain insurance coverage and what she can expect going through surgery. With these pieces of information, a woman can be comforted by knowing what to expect through her breast reduction.
When To Get A Breast Reduction A woman inquiring about functional breast surgery has the best chance to have her surgery covered by insurance.  This woman will have large breasts that have caused her discomfort. Symptoms may include:
  • Chest wall heaviness
  • Neck strain
  • Bra strap irritation
  • Upper or lower back pain
  • Poor posture
  • Tingling or numbness of the fingers
These symptoms will make it difficult for a woman to be active in sports, make her want to wear clothing that will conceal her size and will have worsening symptoms during child bearing years. Typically, these women begin as a D cup or higher and wish to be reduced to a C cup or smaller. How To Obtain Insurance Coverage For a woman to be covered under insurance, it is essential for her provide the following information to her insurance carrier:
  • The estimate describing the amount of reduction from the procedure (most patients will go from a D or DD cup to a C cup)
  • A detailed list of the symptoms present and their duration
  • Any records of a non-successful conservative treatment period
  • Documentation regarding her condition and any attempts to reduce symptoms from her primary care doctor
  Anticipating The Surgery After a patient goes through surgery, she can expect the following, as part of the plastic breast surgery procedure:
  • Overnight stay in the hospital
  • Pain level roughly between 2 and 5 on a scale of 1 to 10
  • A return to work within around two to four weeks (dependent upon the patients type of employment)
  • Partial or full return of nipple sensation and ability to breast feed in 90% of patients
  • The breast shape lifted, as well as reduced
During my 30 years as a plastic surgeon the breast reduction procedure has been by far the most appreciated by my patients. I attribute this to the fact that they not only feel better with the reduction of symptoms, but they also have an improved appearance. The most frequent statement that we hear after the procedure is, “I should have done this years ago.”  Joseph W. Rucker M.D.
Article by
Eau Claire Plastic Surgeon