5'6", 135 pounds, 32G. Will insurance cover a breast reduction?

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions. This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive

See my previous answers on this topic.  This answer is difficult to answer without knowing what type of medical insurance coverage you have. You should call your insurance company to discuss their policy regarding breast reduction to see if they cover it. You do sound like a candidate for a breast reduction and a Board Certified Plastic Surgeon can probably accomplish your size goal. It is difficult to tell you how much tissue they will excise or even if you are a candidate for insurance coverage without an examination. So find a plastic surgeon in your area to discuss this with. #BreastReduction #PlasticSurgery #Macromastia #Medicalinsurancecoverage

From your description you should qualify for a breast reduction, however it will depend on your particular insurance policy. Insurance companies have guidelines that they follow and they are not all the same. The best way to find out is to contact your insurance company, or see a Board Certified Plastic Surgeon who can help you apply for benefits. Most insurance companies require a minimum of 500cc needed to be removed from each breast. Good luck!

Everything you wrote sounds like you are a very good candidate for breast reduction surgery covered by your insurance company    As long as you are non-smoking, you should be able to achieve a good outcome.  Insurers differ in their requirements   The best way to find out what yours requires for breast reduction surgery is to research your policy on their website     The procedure code or cpt code for breast reduction surgery is 19318.  The diagnosis is symptomatic macromastia  icd9 code 611.1.  Most insurers require a minimum amount removed based on a scale that uses your body surface area.  Other things some insurers require are supporting documentation of rashes or musculoskeletal pain relief measures treated from physical therapist, chiropractor or other physician.  This is part of the 'conservative measures' that insurers like to see documented before approving the breast reduction surgery   Your plastic surgeon's office should help guide you through this process but a little leg work on your own will also streamline the approval process   Good luck   You will not regret the decision to have breast reduction surgery.   The most common comment I hear from my patients is 'why didnt I get this done sooner'.

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. BasuHouston, TX

You have to check with your insurance company to determine what their criteria are for approval. It sounds like you are a good candidate.

It does seem as though insurance would cover a breast reduction for your size and the size of your breasts. Pictures would be sent to the insurance company as well as measurements and also any issues which you may be having regarding symptoms of your large breasts.  It does seem as though insurance would cover your size of breast.  The medical issues may not necessarily taken into consideration but it is certainly helpful to state all the issues that are involved. 

lvh, Whether or not insurance will cover breast reduction depends on their internal criteria, and how much they try to save the company by denying elective, albeit necessary, procedures.  There is often a list of hurdles that are set up by insurance companies before approval, such as weight loss (you do not seem to need that from your BMI), 3-6 months of physical therapy, etc, and those interventions are seemingly aimed at stalling long enough for the patient to switch to another insurance company, in my experience.  Weight loss does  sometimes help appropriate patients, but physical therapy is seldom of any benefit, in my experience, as the physical problem is not muscle conditioning, but rather ergonomic problems with supporting oversized breasts with oversized bras and the attendant impact on the support muscles of the upper core and shoulder muscles.  Requirements for specific weight of tissue required to be removed at reduction is also rather naïve on the part of the insurance companies, as it fails to take into account the impact of a proportional G cup in a short woman with a 32 band, as opposed to G-cup in a tall woman with a much larger bra band, where the proportional G-cup would be much larger. In this situation, removal of 300 grams of tissue may make a 32 G much smaller, but would barely make a dent in a 38 G size, where much more tissue removal would be proportional.  Realize that with each band size increase, the relative size of each specific cup gets proportionally larger, so that a 38 C cup is actually larger than a 32 DD cup in the same manufacturer bra line and style. Try it the next time you are in a bra department.Nonetheless, if you are having upper back, neck, shoulder, and interscapular (between the shoulder blades) pain, they are generally reliably relieved by breast reduction surgery, and my reduction patients are among the most gratified.  How small you can go depends on both your desire, and the physical geometry of the breasts, especially the base width, as breasts with wide bases need to be kept a little larger so that the geometric proportion of breast base width to breast projection still allows reconstitution of a properly shaped breast pyramid, and one that will still fit a bra. A breast that is too wide and not at all projecting may not be as aesthetically pleasing to you, so that needs to be considered.  The breast bases can generally be narrowed a little during reduction, but it hard to narrow it by 4-5 cup sizes which would represent a move from a G to a C cup, depending on the sizing system, which is rather arbitrary in the first place.  I hope that this helps.