36DDD Candidate for Breast Reduction? And is It Possible Insurance Will Cover?

Question

28 years old. I am 5'4" and 145 pounds I wear a 36DDD, however my L side is much larger than my R so I tend to bulge out on the L and have a little extra room on the R. My neck, back are in pain. I have headaches, numbness in my hands and groves in sholders from my bra. It is very difficult for me to do any cardio because it is to hard on my back and breast from them to be bouncing all over. I do have factor 5 leiden but have never had any clotting issues with past surgeries, with lovenox after.

Larry S. Nichter, MD, MS, FACS · Answer

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). 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. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions. This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive

Tom J. Pousti, MD · Answer

Based on your description you may be an excellent candidate for breast reduction surgery.  This operation tends to be one of the most patient pleasing operations we perform.

	Sometimes breast  reduction surgery is covered through health insurance. 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. 

	When dealing with health insurance companies, prepare to be persistent.

	 Best wishes.

Adam J. Oppenheimer, MD, FACS · Answer

I'm sorry to hear about the difficulties you are having with macromastia (large breasts). Your complaints are quite typical, and many women have undergone breast reduction surgery with successful resolution of these symptoms.

	Insurance generally will generally cover a breast reduction surgery when such complaints are present and if a certain volume reduction can be performed. The Schnur Sliding Scale is often used to determine whether or not a breast reduction will qualify.  In order to use this scale, you need to determine your BSA or body surface area.

	If you are 5'4" and 145lbs, your BSA is around 1.7.

	Using the Schnur Sliding Scale, your surgeon would need be able to remove around 370g of breast tissue per breast in order to have this covered. Your best course of action would be to seek consultation from a board certified plastic surgeon for evaluation. I think the procedure is indicated in your case, not only because of size, but also because of asymmetry. A balanced appearance to the breasts should be able to be attained following surgery.

	I think the more pressing concern is the history of Factor V Leiden and the potential for deep venous thrombosis (DVT). In such situations, the use of lovenox postoperatively may increase your risk of hematoma formation or bleeding within the breast. Close follow up with your surgeon should be maintained if you decide to proceed with surgery.

Curtis Wong, MD · Answer

and your insurance should cover but sometimes you have to provide documentation of your symptoms, which to me are simply stall tactics by the insurance industry.  Your doctor will take the appropriate precautions regarding your Factor 5 problem to make this as safe as they can for you.

Steven Wallach, MD · Answer

You may be a candidate for a breast reduction but it is best to be seen in person. Insurance may or may not cover it depending upon your plan and their criteria.

36DDD Candidate for Breast Reduction? And is It Possible Insurance Will Cover?

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36DDD Candidate for Breast Reduction? And is It Possible Insurance Will Cover?

Answers (5)

Answer: Breast reduction would be appropriate for you

Answer: Breast reduction would be appropriate for you

Answer: Breast reduction

Answer: Breast reduction

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.