Am I a Good Candidate for Breast Reduction? Insurance Wise?

I'm 18 yrs old and I am a 28f I am 5'1 115 pounds I have back pain and my bra straps are constantly digging. I have horrible posture ,self esteem and they caused me to be clinically diagnosed with severe depression. I just really need them gone to 34B at the most ill even take a 32A.I hate them. I don't go swimming and are refraining me from being active and I know they can only get worse.

Doctor Answers 9

Candidate for reduction mammaplasty?

From your description, you are a good candidate for a reduction.  You should have this authorized either on the anticipated weight to be removed or from your clinical history of depression that is attributed to your breasts.  Please remember that numb nipples can happen as well as affecting your ability to breast feed.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast Reduction Candidate?

Based on the description of your breasts and symptoms, you sound like a good candidate for breast reduction surgery covered by insurance. Schedule an evaluation with an experienced board certified plastic surgeon. The surgeon you choose and his/her office will be able to coordinate authorization from your health insurance to schedule your surgery. Best wishes!

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 164 reviews

Am I a good candidate for breast reduction?

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.  It is difficult to answer your question without a physical examination and discussion of your complaints.  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 26 reviews

Insurance coverage

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

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 212 reviews

Breast Reduction Candidate?

I am sorry to hear about the problems your breasts are causing, both from the physical and the psychosocial standpoints.  Based on your description, you certainly sound like you may be an excellent candidate for breast reduction surgery.

Sometimes the procedure 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. 

Select your plastic surgeon carefully. Ask to see lots of examples of his/her work. Communicate your goals carefully;  be careful about using cup size  as a reference point, given that  bra sizes will vary and  can therefore be a source of miscommunication.  Also, make sure you learn about the potential risks/complications associated with the procedure,  about the presence of scars, and the potential need for additional surgery.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,501 reviews

Look at the requirements from your policy

You need to go over the insurance policy requirements with your plastic surgeon.  It is usually mentioned in your policy booklet and if you can't find the requirements then your plastic surgeon can help you.  The requirements are based on height and weight and how much breast tissue can be removed and your symptoms.

Andre Aboolian, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 60 reviews

Candidate for breast reduction

Unfortunately, many patients who qualify medically for breast reduction do not qualify under the terms of their policy.  You may have to pay for it yourself, or change insurance companies.  It is an outpatient procedure.

Talmage  Raine MD FACS

Talmage J. Raine, MD, FACS
Chicago Plastic Surgeon
4.6 out of 5 stars 9 reviews

Breast reduction

Each insurance company has different criteria for approval. An exam in person will be m ost beneficial.

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

Breast reduction

The criteria that insurance companies use for breast reduction surgery depends on the weight of breast tissue which would be removed from each breast, in addition to your symptoms.  Without photos, it is impossible to,give you an idea.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 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.