Will insurance cover a breast reduction? (Photo)

Ok. I'm 5'3 and 125lbs. My breasts went from a 34C to 34H from my pregnancies. I want to go back down to a C/D but have 1 more child to have and they seem to grow more each pregnancy. I also have scoliosis 17 degree curvature and my breasts are almost down to my waist and I'm only 23!

Doctor Answers 9

You need to call your insurance

You need to call your insurance company to see what they say.  Next you need to find a plastic surgeon who takes insurance and have him/her call your insurance company to check your benefits.  If you have a HMO then you need to see in network plastic surgeons and if you are PPO then you can choose your plastic surgeon assuming he/she accepts insurance benefits.  When choosing a plastic surgeon make sure to review the before/after photos to see if you like the results (make sure they show you three views from each patient; front, quarter turn and profile views)

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 55 reviews

Will insurance cover a breast reduction?

There are many different insurance policies and each has its own guidelines in terms of covering breast reduction.  In general they want documentation of your symptoms such as back, shoulder, and neck pain, recurrent infections in the inframammary fold, deep bra strap grooves, for a period of 3-6 months.  Some require documentation of physical therapy and gate training.  I have addressed this issue many times and I suggest you read my previous posts.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 17 reviews

Insurance coverage for breast reduction?

Every insurance plan has different criteria for breast reduction approval. I would check to see if your policy has any specific exclusions in this regard. You obviously have a very full size for your small frame. The scoliosis is very likely to make this situation worse with normal aging. Given that you plan another child, it may be prudent to wait if possible until after your last pregnancy in order to preserve your post-surgical result. A plastic surgeon in your local area with experience in breast reduction, can assist you with your approval when the time is right. Thank you for your question...and, best of luck to you.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 15 reviews

Breast reduction covered by your insurance?

Breast reduction is covered by your insurance if you meet the qualifications required. I suggest you see Dr. Ali Tehrani in Apple Valley.

Arian Mowlavi, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 41 reviews

Insurance to cover breast reduction

Thank you for your question and this is a common question but simply put you will need to discuss this with your plastic surgeon.  Each insurance company has different requirements to qualify for the procedure and I would first check with them to see if it is a covered benefit. Insurance companies have made it difficult to get these approved and you have to have meet the criteria  which may take up to six months to a year to complete.  If you want to have another child then I would recommend that you wait until you have finished having children because your breasts may change even more.

John D. Smoot, MD
La Jolla Plastic Surgeon
5.0 out of 5 stars 12 reviews

Will insurance cover a breast reduction?

As a rule insurance companies often cover breast reduction if you meet all the requirements of your specific contract. The only way to find out is to see a surgeon for an exam and then have your surgeon contact the carrier for preauthorization. Companies usually have a minimum weight to be removed and it takes an exam to know what that number might be in your case. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Breast reduction covered by insurance

Insurance companies all have their own criteria that must be met for a breast reduction to be covered. One involves how much tissue (in weight) is removed in proportion to your height and weight. They also may require you to have some visits with your primary care or orthopedic surgeon to document that you have tried other things before resorting to surgery. You sound like you will meet all criteria and should be quite pleased with the procedure. I would call the plastic surgeon of your choice and they can help you with the specifics.

Karen Quigley, MD
Memphis Plastic Surgeon
4.8 out of 5 stars 24 reviews

Will insurance cover a breast reduction?

Congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.

Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, 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. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. Also, prepare to be persistent when dealing with health insurance companies.

I hope this, and the attached link, helps. Best wishes for an outcome that you will be very pleased with.

Will insurance cover a breast reduction?

Thank you for your question.  Insurance companies will vary with their criteria for breast reduction so it's important that you check with your insurance.  Be sure to consult with an experienced board certified plastic surgeon to assist you in the process.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 14 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.