Schnur Sliding Scale for Breast Reduction

Question

My insurance company states according to the Schnur Sliding scale, I would need 527 grams removed from each breast as one criteria.  I am currently a 38DD with severe upper back and shoulder pain.  What size would I become if the 527 grams were removed from each breast.

Richard J. Bruneteau, MD · Answer

It’s not unusual for
insurance carriers to require that minimal amounts of breast tissue be removed
during breast reduction. This amount varies from insurance carrier to insurance
carrier. Many insurance companies now use the Schnour Sliding Scale to make
this determination. This scale adjusts the tissue removal requirements based on
weight/height calculations. In many cases, the resultant weight criteria may be
in direct conflict with the patient’s aesthetic goals.

Unfortunately,
without the ability to view pictures or perform a physical exam it’s virtually
impossible to estimate your final breast size. This is further complicated by
the fact that cup size tends to mean different things to different people and is
a frequent source of confusion.

Based on your
history it would be reasonable to estimate a C cup, but this is only an
estimate. It’s important to discuss this issue with your plastic surgeon. Your
surgeon should be able to give you some insight into your final breast size
after a 527 gram breast reduction.

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

Breast Reduction is a complicated procedure that is best done by those with the most training and experience. It is very difficult to determine the resultant cup size and shape based solely on the number of grams that are removed from your breast to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast reduction and lift surgeries, including different approaches, techniques and even fat transfer and implant choices if you are lacking superior breast fullness.This is because several measurements—not to mention breast characteristics such as density—are needed to determine how much and where to remove breast tissue to meet your goals. Without knowing your existing breast shape, dimensions, and the density of your breast tissue, it would be difficult to make this determination. For example, the same volume of breast tissue will weigh different amounts (measured in ounces or grams) in different people depending on its density. The existing base width of your breast and what you will ultimately want to look like will determine, in many cases, the maximal volume and weight that will need to be removed for the best result.Please click on the link below for more information!

Scott C. Sattler, MD, FACS · Answer

As I'm sure you recognize, its impossible to answer this question without a photograph or a physical exam.As stated previously, breast tissue varies somewhat in density- but more important to this analysis is evaluating what volume your current breast occupies. Bra cup sizes are an inaccurate representation of breast volume, since most women do not wear a correctly fitted bra. Also, there is no standardization of bra cup size between bra manufacturers.  So, its difficult to speak accurately about post-operative breast size after reduction without a set of chest and breast measurements.In the plastic surgery literature, there have been a few formulas and tables developed that attempt to predict the resection weight that would result in a decrease in one 'cup' size, but the accuracy and reliability of these tables has been called into question.Probably the best predictor of breast size is the experienced opinion of a plastic surgery that does a lot of breast reduction surgery.

Jeffrey Horowitz, MD · Answer

Breasts are made up of some percentage fat and some percentage breast gland.  As women age, a greater percentage of the breast is replaced by fat.  Glandular tissue weighs much more than fat for the same given volume.I would recommend evaluation by a board certified plastic surgeon.  Based on the density of your breasts, he or she will be able to tell you how much smaller your breasts would be made by resecting about 500 grams of tissue.Good luck!

Tom J. Pousti, MD · Answer

Congratulations on your decision to proceed with breast reduction surgery. It is one of the most patient pleasing operations we performed. 

	Unfortunately, there is no direct correlation between the amount of tissue removed and the ultimate cup size that a patient will wear after breast reduction surgery.

	Before undergoing the breast reduction procedure it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

	Best wishes.

Carmen Kavali, MD · Answer

Most women don't wear the correct size bra, so I'm not even sure you're really a DD cup. Also, skin fills a bra cup, just as breast tissue does. Without an exam, or at least some good photos, it's impossible to predict a postoperative size after removal of 527g of tissue from each breast. Your plastic surgeon should be able to give you a good estimate when you meet for consultation, though. Best wishes!

Pat Pazmino, MD, FACS · Answer

Patients today have many great options to effectively reduce and contour their breasts. In our practice, we work closely with patients to understand what their goals are and how much breast tissue is necessary to alleviate any pain symptoms that they may have and to obtain the look that they are looking for. Before the surgery, we can sometimes give an estimate as to how much tissue will be removed. However, there is no exact way to determine how much breast tissue will be resected. Be sure that you review your insurance policy and how closely with your plastic surgeon about your goals. Remember that these are the breasts that you will live with aunt is more important for you to obtain the results that you are looking for then to satisfy a meaningless number for an insurance company.

Steven Wallach, MD · Answer

It is very difficult to predict your final cup size after reduction even after examining you.  This is because each bra company is different. However, a rough estimate can be predicted after an exam.

Hisham Seify, MD, PhD, FACS · Answer

Most plastic surgeons still feel frustrated that they have to change their operative plan based on the number of grams to be removed from the breast.In general, every cup size is 150-250gm. Your 527 gm excision will give you a full D/Small D cup size. Best of luck!

Peter A. Aldea, MD · Answer

Dr. Schnur, former President of the American Society of Plastic (and Reconstructive) Surgeons came up with this formula to get insurance company to stop demanding that 500 gm be removed from each reduced breast regardless of the woman's size. The formula weight with body surface area which is a fairer more accurate way of getting More from larger women and less from smaller women as as not forcing insurance companies to pay for minimal breast reductions / or breast lifts.
Obviously, it would be presumptuous of me without the benefit of an examination, or even several photographs, to predict your post-operative cup size after removal of 527gm. No one can do it. Moreover, even with an examination it would be an educated guess not a promise.
That being said, it has been my experience that it would still comfortably leave you in a C cup range.
Discuss this with your Plastic surgeons and see what he/she says.
Good Luck.

Schnur Sliding Scale for Breast Reduction

Answers (12)

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