5'2", 140lb, 36DD - Am I a Candidate for Breast Reduction?

I have always had large breasts, ever since age 14. I have recently realized they are probably what caused my poor posture,I am unable to sit/stand up straight for long periods of time with out slouching or having back pain. I have also been having lots of shoulder and upper back pain. My insurance uses the Schnur Sliding Scale, do you think I would be covered?

Doctor Answers 7

Breast reduction

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It sounds like you would be able to get your surgery covered by insurance because of the pain you're feeling. Consult with a board certified PS who will examine you and make sure breast reduction is right for you. They will then help you get insurance approval.

5'2", 140lbs, 36DD - Am I a candidate for breast reduction?

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Hello! Thank you for your question.  It is a safe procedure, in which your plastic surgeon will reduce the amount of breast tissue, reshape your breasts, raise the nipple-areolar complex to its appropriate position (possibly making the size smaller, if needed), and ultimately ameliorate the possible complaints that you do have for the reason that you are having this procedure (e.g., neck/back pain, migraines, rashes/infections, shoulder grooving, etc).

It would be in your best interest to have a mammogram prior to the procedure for screening prior to this procedure, as the architecture imaging of your breast will slightly change afterwards. Well known data exists that having a breast reduction will in fact lower your chance for developing breast cancer, simply because the amount of tissue will be less.

Consult with a board-certified plastic surgeon who will discuss the procedure with you, examine, and assist you in determining if this is the right procedure for you.  Voice your complaints - your insurance will likely require a detailed description of your history and complaints as well as photo and an estimate of how much tissue will be removed.  You should give a description of the therapies that you have done to ameliorate your complaints thus far.  Any other notes from other physicians is helpful.  It would also behoove you to discuss your issues yourself with your insurance carrier.  Hope that this helps!  Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Insurance coverage

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Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.

Best wishes,

Dr. Basu
Houston, TX

Candidate for Reduction and Insurance coverage?

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From your description, you will certainly benefit from a breast reduction. BUT I would definitely meet with a plastic surgeon and look at before and after to determine if you will be okay with the incisions. There are many issues to resolve and it is best done with both you and another family member present.  Getting breast reduction covered under insurance is very difficult. In fact getting them to tell you, as the consumer, the number of grams needed to get coverage will be nearly impossible. I suspect in the end it will have to be paid out of pocket.  The insurance frequently places the restrictions and makes it difficult without any medical substantiation. I have had many difficulties with my own patients (who truly needed it)  getting coverage. The best way to get coverage is to call your insurance company (my patients really raised a stink)...remember you are the consumer and you are asking insurance to cover a procedure that your doctor deems is medically necessary.

Insurance Coverage for Breast Reduction Surgery

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Thank you for your question.

Each insurance company differs with what they need to approve the breast reduction surgery.  The only way to know if your insurance will cover this procedure is to visit with a board certified plastic surgeon and ask that they submit paperwork asking for authorization.

In my office, we send a letter as well as the chart notes and photographs of the patient.  If you have any documentation from other doctors (chiropractors for back pain, general practitioner for rashes, etc.) it will be helpful to get letters and submit those letters along with the request for authorization.

Best wishes.

Candidate for breast reduction?

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If your large breasts are causing problems with back pain and proper posture, you are a candidate for breast reduction surgery. Most plastic surgeons will do this either as a cosmetic procedure (you pay for it) or reconstructive, in which case the insurance pays. You should schedule a consultation with a plastic surgeon certified by the American Board of Plastic Surgery who will be able to help you determine whether your insurance policy will cover the surgery for you. Good luck.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

Insurance candidates for breast reduction

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In short you are a candidate for breast reduction, thouhg the issue for many is will insurance cover the cost? The Schnur scale was worked up in the 80's and is obsolete in our area. Insurance plans, even those that look similar are all different and we depend on a written predetermination of benfits to confirm coverage.

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

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.