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.
