Will Medicaid Pay for 36DDD Breast Reduction (Age 15)?

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.

It is nearly impossible to find this out prior to surgery. Furthermore, it may be difficult to find a surgeon willing to perform this at Medicaid Rates. Lastly, your parents will have to consent.

I am not familiar with Medicaid but can comment on private insurance.  Every private 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