Is It Possible to Get a Breast Reduction Approved by Insurance when You Are a Large C? (photo)

I am 34 year old mom of two. I lost about 100 lbs after the birth of my children. The problem is I need a reduction but am about a 32C/D. I need to know how to have insurance cover the procedure. I have to constantly duct tape by breasts up and wear an underwire, if I don't I get a rash. As of late wearing any bra besides a strapless aggregates a chronic shoulder condition. Any tips? I go for a consultation on the 5th.

Doctor Answers 15

Breast lift not reduction

I don't think a reduction would help you, since it's sagging that's more of a concern judging from your photos. A breast lift won't generally be covered by insurance.

Paramus Plastic Surgeon
4.7 out of 5 stars 140 reviews

Breast reduction in a C cup patient

Your photo shows C cup breasts with some ptosis (sagging). I doubt this would be covered by insurance as they require somewhere around 500 grams of tissue to be removed. In your case, very little tissue needs to be removed. You need more of a breast lift.

Kurtis Martin, MD
Cincinnati Plastic Surgeon
4.8 out of 5 stars 74 reviews

Breast reduction questions

To tell you the truth, you look like you need a lift and not much of a reduction.  I don't think insurance will cover the cost, but you never know.  Ask the plastic surgeon at your consult if hey think it is worth undergoing the preauthorization process. What they cover can be hit or miss, so you never know.  It's worth trying.

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

Insurance coverage for breast reduction

Not only does each insurance company have its own requirements, each policy may have different ones. Insurance should cover only medically necessary procedures and in your case the medical reasons for surgery do not seem to be the usual back pain as much as they are the rash underneath and aggravation of your shoulder condition. After your consultation, your surgeon should send a letter to your insurance company explaining your reasons for surgery and why it is medically necessary. They may still decline to cover it, but you can appeal their decision which would give you another chance to state your case for it being medically necessary. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon
3.6 out of 5 stars 13 reviews

Is It Possible to Get a Breast Reduction Approved by Insurance when You Are a Large C? (photo)

You need a letter of "predetermination" addressed to your health insurgence company from a boarded PS. Include photos. Odds are not in your favor to have coverage but worth the time and effort. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Some Breast Reductions are covered by insurance

All health insurance carriers differ on their criteria for covering breast reduction procedures.  Your plastic surgeon will need to submit a pre-authorization letter to see if you meet their requirements.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 75 reviews

Is It Possible to Get a Breast Reduction Approved by Insurance when You Are a Large C? (photo)

It does not appear that  you will qualify for insurance  coverage

With the advantages made in breast reduction techniques, it is possible to have a breast reduction done in the surgeons office under twilight anesthesia

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Breast Reduction and Insurance Coverage?

The only way to know for sure if your reduction will be covered by insurance is to get a consultaton and have the surgeon attemp to preauthorize the procedure. From your photos it does not look like you are large enough to qualify for insurance.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast Reduction and Insurance Coverage?

Congratulations on your significant weight loss.

 Online consultants cannot, with any degree of certainty, predict whether a specific insurance company will cover a specific patient's breast reduction procedure. My guess:  in your case, most health insurances would not cover the procedure,  based on the “weight requirements” (weight of tissue removed during the breast reduction procedure) that most health insurances follow.

Your best bet is to seek in-person consultation with board certified plastic surgeons whose work you like;  that plastic surgeon may be able to communicate with the health insurance company on your behalf. Make a list of the “problems” that the breasts are causing you and seek as much support as possible from other physicians as well ( in the form of letters).

 Also, communicate your goals clearly. Remember that “B cup” may mean different things to different people; discussing cup sizes may be a source of miscommunication.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,504 reviews

Breast Reduction with C cups

     Breast reduction from a C cup to a B cup will likely not remove enough tissue to meet the insurance requirements.  Additionally, if you like the volume of your breasts, then only a breast lift should be performed.  The breast lift procedure is never covered by insurance.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 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.