Based on your description you may be an excellent candidate for breast reduction surgery at some point; it will be in your best interests to drop weight first. Doing so will help decrease the risks of surgery and help minimize the chances that additional surgery will be come necessary in the event of weight loss that occurs after the breast reduction procedure. The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you are consulting with a well-trained/experienced board-certified plastic surgeons. When dealing with health insurance companies, be prepared to be persistent. Keep in mind, that breast reduction surgery tends to be one of the most patient pleasing operations performed. I would also suggest that you communicate your goals clearly with your plastic surgeon and make sure that you have realistic expectations prior to proceeding with any type of surgery. In regards to breast size desired, also communicate carefully. In my practice the use of goal pictures are helpful in this regard; a discussion of cup size can be confusing and imprecise. Therefore, I would not suggest that you communicate your goals and/or base your satisfaction with the outcome of surgery on achieving a specific cup size. I also find that the use of pictures is more helpful than the words “natural” or "proportionate” etc., which can mean different things to different people. Many of my patients choose to have enough breast tissue removed to help alleviate symptoms while retaining enough breast tissue to remain proportionate to the remainder of bare torso. Again, preoperative communication will be critical. I hope this, and the attached link, helps.