Why Won't Doctors Accommodate D Cup to B Cup Breast Reduction?

I am a "D" cup and would like to be a "B" cup. Why won't most doctors accommodate this for breast reduction?

Doctor Answers 22

D to B cup reduction

There is no intrinsic reason why this is not possible or advisable. You should ask your surgeon why this is not specifically recommended for you. I generally will listen to the patient and try to give them what they want along with the risks and pros and cons of the treatment necessary. Your surgeon should listen to your wishes.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Breast Reduction Size

It is impossible to reliably determine breast cup size with a breast reduction. Breast cup size is very nonspecific and is related to the chest width and the breast size itself. As such we are unable to be reliable regarding what is a B, C or D cup during surgery. I give my patients 3 options; small, medium and large.

Small=take off as much as possible

Medium= appropriate for body build

Large= Take off enough to satisfy insurance but I want them lifted

In addition most breast reductions are done keeping the nipple attached to the breast tissue. The blood supply comes through the breast tisue so there needs to be enough tissue there to supply the blood. If you take out too much breast tissue you may loose the blood supply to the nipple and it would die. Under those circumstances the nipple would be removed and placed as a skin graft, a much less desirable result.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 32 reviews

Breast reduction and breast size after surgery

If the patient is planning on losing weight I always suggest that the patient lose weight before having surgery as the size and shape of the breast may change after surgery. When discussing final size of the breast after breast reduction two points most be taken into consideration. The first being the height, weight and frame of the patient. A small breast on a larger size patient would be out of proportion. The second being the amount of tissue needed to support a nipple.

When one is performing a breast reduction tissue is removed from around the breast. Removing too much tissue although giving a smaller size can compromise the blood supply to the nipple. A good examination should help determine what the breast size can be safely reduced to.

Sharon Theresa McLaughlin MD
Long Island City Plastic Surgeon

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D to B cup Breast reduction is possible

Without a physical examination and review of your medical history I can't say why the surgeon you consulted with won't agree to reduce your breasts from a D to a B cup. If you are seeking insurance approval for this surgery they have specific standards for medical necessity which differ from each insurance company.

The standard requests from most insurance companies to receive medical necessity approval for breast reduction surgery includes the following:

1) Examination by a plastic surgeon with breast measurements and number of grams per breast to be removed.

2) Member has persistant symptoms of at least two anatomical areas (upper back pain, neck pain, shoulder pain, headaches, kyphosis and/ or pain from bra straps cutting into shoulders) for at least 3 months to a year and documented by family physician and or gynecological physician.

3) Photographic documentation confirming severity of breast hypertrophy.

4) The number of grams to be removed correlates with the approved required amount using the Schnur Sliding Scale for breast reductions surgery. This scale uses your BSA (body surface area, which is calculated by your weight and height) to determinte the number of grams necessary for medically necessary approval.

Some insurance companies also reguire letters of support from your primary physician and or conservative treatment to address your symptoms for a minimum of 3 months or greater. Conservative treatment usually includes physical therapy, orthopedic treatment, chiropractic care, prescriptions for pain relief from your primary physician and sometimes massage treatment.

Best of luck with your pursuit for a breast reduction surgery.

Peter C. Haines, MD
Columbia Plastic Surgeon
5.0 out of 5 stars 11 reviews

D-cup to B-cup Reduction

There should not be a problem in having D-cup breasts reduced to a B-cup.  Perhaps the surgeons that you have seen were concerned that insurance companies would not cover the procedure or there may have been other issues (health concerns, etc.) which dissuaded them.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Who says they won't

First of all - there are no standard sizes of breasts - no one knows exactly what a B is. I try to accomodate my patients and give them about the size they desire. If you don't like what your doctor says, get another opinion.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.1 out of 5 stars 11 reviews

Breast reduction depends on your body type

Though it is difficult to give you a straight answer without an exam, it is usually quite easy to give patients a B cup from a D cup. Perhaps your particular breast and chest wall shape prohibit such a reduction, but we are able to do that on most patients pretty easily. I would continue looking for doctors in your area.

I hope this helps.

Robert Steely, MD, FACS
Houston Plastic Surgeon
4.8 out of 5 stars 51 reviews

D to B reduction

This should certainly be possible, but there may well be reasons why it is not being recommended.  Common limitations on breast reductions include operative risk, certain technical limitations,, compromised blood supply to the remaining breast/nipple complex, or maybe not enough tissue can be removed in order to qualify as a breast reduction for insurance payment purposes.  Ask your surgeon why.

Jeffrey D. Wagner, MD
Indianapolis Plastic Surgeon
4.9 out of 5 stars 20 reviews

Breast reduction cup size?

Hello! Thank you for your question. In general, breast size does not correlate with bra cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance.

Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory (e.g, incision, lift, use if implant, etc). I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative planning and creating the most aesthetically-pleasing breast for you.

Hope me that this helps! Best wishes for a wonderful result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 25 reviews

Plastic Surgeons Define Cup Sizes Differently Than Breast Reduction Patients

It’s not unusual for breast reduction patients to start out with D cups and end up with B cups.  This is a common scenario in most plastic surgery practices.
I suspect that the surgeons that you have seen, are reluctant to guarantee a cup size following breast reduction surgery for a variety of reasons.
It’s not unusual for cup size to be defined differently by different people.  Patients frequently know their bra size and confuse this with their actual breast size.  This can cause confusion because different bra manufacturers label their bra sizes differently.  This can make cup size discussions between surgeons and patients difficult.
The surgeon must also deal with patient safety issues.  Attempts to over reduce the breast can potentially damage the blood supply to the nipple areola complex and lead to an increased complication rate.  In addition, insurance carriers may have weight removal requirements as well, which may ultimately affect cup size.
For all these reasons, most surgeons are reluctant to make guarantees regarding cup size, and prefer discussing broader aesthetic goals.  These include shapely breasts with good contour that have proportion, balance and harmony with the surrounding structures.

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.