I Am 62 Inches Tall, 200 Lbs Have Neck and Back Pain 38DDD Wanting Breast Reduction?

I have anthem and wanting to know if I met the qualifications. I have tried NSAIDS for the past 6 months with no relief also have tried good supporting bra with wide straps, had CT of neck and neck xrays that showed nothing. I have lost 12 pounds and not lost any in my breast area, my breast sag and one breast is slightly larger than the other. I have a letter from my primary care physician saying that my neck pain is from my breasts.

Doctor Answers 5

Good candidate for breast reduction.

Women with excessively large breasts that that are symptomatic and have objective findings consistent with gigantomastia are good candidates for breast reduction. It sounds like you're ready to proceed.

Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Breast reduction.

You have done most of your work. Congratulations !!! Anthem in Indiana & Kentucky have the their criteria for Breast reduction approval on their website. There you can check if you fulfill them. See a Plastic Surgeon and he/she will send a letter to the Insurance for "pre determination". Once You and/or your Plastic Surgeon receive the "approval number" from the Insurance Breast reduction can be planned.

From you description you appear a good candidate for this procedure. It does not mean your Insurance necessary "agrees" and "sponsors" you for the Surgery. More patients start to pay out of their own pocket the surgery not to depend on the "approval" of the Insurance.

Good luck

Guido P. Gutter, MD
Evansville Plastic Surgeon
4.9 out of 5 stars 18 reviews

Insurance and breast reduction

Welcome to medicine 2013.  Many insurance companies make it very difficult to get approval and require patients to seek many things to get approval. SOme of which can include other doctor's notes for 6 months or longer stating that you need a breast reduction to resolve your symptoms. Best to ask your insurance company what their criteria are.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

I Am 62 Inches Tall, 200 Lbs Have Neck and Back Pain 38DDD Wanting Breast Reduction?

It seems like you have done quite a bit of homework and you are familiar with the criteria and guidelines.  I am not surprised that your CT and X-rays of your cervical spine did not show anything, they usually don't and the neck and shoulder symptoms are subjective for the most part.  However, given that you are a DDD cup it seems you have satisfied the guidelines of your insurance company.  However, they still will need a pre-determined amount of breast tissue to be removed before they process the payment.  Now all you need is an experienced plastic surgeon certified by the American Board of Plastic Surgery (no other credentialing system is up to par with this highest standard) who will work with your insurance company.  Best of Luck.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

Breast Reduction Candidate?

Thank you for the question.

Based on your description you may be a good candidate for breast reduction surgery; it may be in your best interest to drop weight first. Achieving a long-term stable weight prior to proceeding with surgery will increase safety of the procedure and decrease  chances that additional surgery will be necessary in the future.

 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.

 I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 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.