I'm 24, 5'8" and 180lbs. I'd like to lose 20lbs before getting a breast reduction to a C, but I've always been big busted. At least a D, even when I weighed 145 2 yrs ago. I just had twins 6 mo's ago so sagging is an issue too. Just wandering if a breast reduction will be ideal (thinking in terms of ins. coverage). I have very good insurance, but I know how difficult it can be to get these types of surgeries covered. I have had back pain since before I can remember as well as posture problems.
Is a 36DD Too Small to Get a Breast Reduction?
Doctor Answers 12
Breast Reduction: insurance candidate
In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities
Breast Reduction Candidate seeking insurance coverage
There are a series of questions that must be answered prior to beginning the insurance process.
1. Have you experienced persistent symptoms in at least two of the anatomical body areas below, affecting daily activities for at least one year:
Pain in upper back
Pain in neck
Pain in shoulders
Painful kyphosis documented by X-rays
Pain / discomfort / ulceration from bra straps cutting into shoulders;
2. Have you had a mammogram within the last year?
3. Have you tried any of the following therapies for 3 months or more?
Supportive devices (e.g., proper bra support, wide bra straps)
Analgesic / non-steroidal anti-inflammatory drugs (NSAIDs) interventions
Physical therapy / exercises / posturing maneuvers
4. Have you seen a physician for the symptoms you have experienced? When?
Your physician must also be able to document symptoms such as back and neck pain, headaches, also needs to ensure that the estimated reduction is consistent with the insurance company’s requirements for your BMI.
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Size is relative to your frame.
Prior Authorization Has To Be Complete Before Knowing if Insurance Will Cover Breast Reduction
Based on your pictures and symptoms, I believe you’re probably a good candidate for breast reduction surgery. Unfortunately, it's almost impossible to know whether or not an insurance carrier will cover the expense of this procedure until prior authorization is complete. Each insurance company has its own unique requirements and some companies consider breast reduction a contract exclusion. This means they won't cover it, even if you're a perfect candidate for surgery.
I believe you would benefit from this procedure in multiple ways. Breast reduction alleviates symptoms associated with breast enlargement, such as back pain, neck pain, breast pain, shoulder pain, and chronic rashes. It improves breast aesthetics by reducing the size of the breast, reducing the areola size, and lifting the breast into normal position. It results in improved self-esteem, self-confidence, and self-image. All of these benefits make breast reduction an extremely popular procedure with high satisfaction rates.
Breast Reduction Candidate?
Thank you for the question and pictures.
Based on your description you may be a good candidate for breast reduction surgery; it is one of the most patient pleasing operations we perform.
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're working with a well-trained/experienced board-certified plastic surgeon.
Insurance and breast reductions
Without an exam it is hard to assess what volume of tissue you have and how much can be removed that can also leave you with a nice shape and volume. Each insurance company has different criteria for approval as well. Good luck.
Insurance coverage of breast reduction
From your picture, I would find it hard to believe that you would be denied but there are a variety of criteria each insurance company may use. Seek a certifed surgeon and have them compose a predetermination of benefits letter to ascertain your level of coverage.
Initial cup size is only one determinant for breast reduction
Many factors are considered when looking at insurance coverage for breast reduction surgery, and a 36DD cup is certainly not too small to consider the potential benefits of reduction. It is courageous of you to submit your picture, and it appears that the DD may not be a 'true' cup size. Often women with a very large breast will wear a bra that they can find be it convenience or fashion and will under-size the true cup. Who really enjoys a custom wide strap G cup bra at your age. When judging breast reduction your height and weight, breast size, distance of the nipple to the neck, and estimated weight of reduction all must be factored in. Based on your photo, if you are strongly motivated to complete a breast reduction, an exam and insurance predetermination is worth a shot.
Best of luck,
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.