Will insurance pay for me to reduce my cup size from 38G to a 36D?

Question

I am 42 years old and wear a 38G bra. I have serious back and shoulder pain. I also have skin sensitivity under my breast. My breast are so heavy that I have to wear 2 bras to support them on any regular day. I am beginning to have headaches now and the should pain is getting worse. I don't have a lot of money and I want to know if insurance will pay if I want a breast reduction and down to size 36C or 36D. I weigh 170

Tom J. Pousti, MD · Answer

Thank you for the question. I'm sorry to hear about the physical and probably psychosocial problems your breasts have caused. Based on your description, you may be an excellent candidate for breast reduction surgery.

	 

	Breast reduction surgery is one of the most patient pleasing operations we perform. By removing “excess” breast tissue, adipose tissue, and breast skin  this operation reduces and lifts the breasts to a higher position on the chest wall. By doing so, patients often find improvement in neck, back, and shoulder discomfort and find it easier to form their activities of daily living and exercise.

	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 the time is right,  seek consultation with well-trained/experienced board-certified plastic surgeons.

	Unfortunately,  no plastic surgeon is able to accurately predict what cup size you will end up wearing after breast reduction.  As you know, breast cup size will  different depending on the bra  manufacturer.  Therefore communicating your goals in reference to achieving a certain cup size may be confusing and/or a source of dissatisfaction.
	I would suggest that you communicate your goals with your plastic surgeon ( I prefer the use of goal pictures)  and ask him/her to do his/her best to achieve the results you're looking for.
	  

	I hope this, and the attached link, helps.

Gordon Lewis, MD · Answer

From my experience, you are a great candidate for a breast reduction.  I do not think you will have any issue getting authorized, but as always you do need a bit of a paper trail.  You should find a surgeon, but also you will likely need a letter from your primary care doctor to support the diagnosis and to describe your symptoms.

Elliot W. Jacobs, MD · Answer

From the way you describe your situation, you sound like an excellent candidate for breast reduction.  It seems reasonable to believe insurance SHOULD cover all or part of the procedure to help you improve your well-being, but whether they WILL pay is another story.   I would suggest you do the following:

	1) Call your carrier and find out exactly under what circumstances they may cover breast reduction

	2) Develop a plan to follow their list of requirements to the letter, which may mean document, document, document

	3) At the appropriate time, consult a board certified plastic surgeon who performs breast reduction often and get surgical recommendation

	4) Be prepared to appeal if you're denied the first time

	If you simply cannot gain the cooperation of your insurance company, you could consider a combination of saving for and financing part of your procedure.  In our experience, breast reduction patients are most often so thrilled with their new, lighter, sleeker bodies that you may well consider it worthwhile even without insurance help.
	
	Elliot Jacobs, M.D.

	New York Plastic Surgeon

Jeffrey Zwiren, MD · Answer

You may be a good candidate for a breast reduction.  You will need to be seen by a plastic surgeon and from that medically necessity will be determined.  An alternative is to call your insurance company, ask for a claims rep and find out the exact criteria for your policy for insurance approval for breast reduction.

Will insurance pay for me to reduce my cup size from 38G to a 36D?

Answers (4)

Answer: Insurance approval for breast reduction surgery

Answer: Insurance approval for breast reduction surgery

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Everything you need to know about Breast Reduction

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Will insurance pay for me to reduce my cup size from 38G to a 36D?

Answers (4)

Answer: Insurance approval for breast reduction surgery

Answer: Insurance approval for breast reduction surgery

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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.