I'm 27 Years Old and Stand at 5'6 1/2 and Weigh 256 Pounds. My Cup Size is 42 M. Would my Insurance Pay for a Reduction?

Doctor Answers 5

New alternative with no vertical scar is The Ultimate Breast Reduction

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Insurance companies pay for breast reductions when you meet 2 criteria.  First, you have to have symptoms related to the large breasts such as neck, back and shoulder pain or rashes.  Second, you must have weight removed that meets their criteria.  Their weight criteria is determined by your height and weight, which determines your body surface area.  At 5'6 1/2 and 256 lbs, your body surface area is 2.3 meters squared.  If your insurance was Aetna, they would require 1 kilogram removal.  At size 42 each 300 grams correspond to 1 cup size change.  1,000 grams would reduce you 3 cup sizes, from a M down to a J.  You may want to be smaller than that.  I recommend a new technique called The Ultimate Breast Reduction.  This technique is done without vertical incisions and the breast weight is transferred to the underlying muscle. This results in immediate pain relief and allows the patient to choose the size proportionate to their body.

Best Wishes,

Gary Horndeski, M.D.

Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Breast reduction coverage

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Breast reduction is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine. Recently, managed care has adopted stricter standards for coverage, so just make sure these problems are thoroughly documented in writing by your primary care physician and plastic surgeon. They may also have to submit photographs. Even then, you may be required to seek a second opinion from a chiropractor, physical therapist, or orthopedic surgeon.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 reviews

Insurance should cover breast reduction

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Insurance coverage for breast reduction has become more difficult, even though plastic surgeons have show improvement in discomfort and improvement in function after surgery. Each insurance plan will differ, and the process starts with a letter of predetermination to see if your particular plan will offer coverage.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Insurance Coverage for Breast Reduction

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Based on your dimensions you appear to be a candidate for breast reduction surgery. If your primary care physician provides documentation and treatment of your symptoms arising from your breast hypertrophy, you should be able to have insurance pay for breast reduction surgery. Sometimes, however, insurance may deny coverage if it thinks that weight loss alone can reduce the size of your breasts. If you are approved by insurance, you could then be evaluated by a plastic surgeon for surgical treatment. Your surgeon will go over the pros and cons of having breast reduction surgery.

Reducing the size and weight of the breasts does make a huge difference in back, shoulder and arm pain, if you are experiencing this.  If you are finding it difficult to exercise, itdoes become easier and much more enjoyable without carrying all the extra weight on your chest.

Thank you for your question. Best of luck!


Gregory C. Park, M.D.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 178 reviews

Breast Reduction and Insurance Coverage?

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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.

 Best wishes.

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.