Does my weight qualify me?

Hello , I have serve back pain , neck pain , due to my breast I'm a 34H I'm 5'5 and weight 160 and I'm on medicad in NC. Does my weight qualify me?

Doctor Answers 3

Does your weight qualify you?

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.

Qualifying for Breast Reduction Surgery

From your height and weight and bra size, along with your symptoms of neck and back pain, I would think that you qualify for breast reduction surgery.   Certainly, breast reduction surgery would help relieve your symptoms.   However, you should contact your state's Medicaid office to find out what their requirements are.   You should also consult with a plastic surgeon who takes Medicaid.   Most private health insurance companies use the Schnur Sliding Scale to determine the minimum amount of breast tissue that needs to be removed from each breast in order to be covered by insurance.   This is done by first calculating your Body Surface Area (BSA), using your height of 5'5" and weight of 160 lbs.   Your BSA is 1.84 m2.  Using the SSS, you would need to have a minimum of 482 grams of tissue removed from each breast.  

Best Wishes!  

Breast reduction, some advices:

Thank you very much for sharing your concerns with us. 
After having analyzed all the information provided to us, i can realize that you have very large breasts for your height and weight, and can be responsible for head, back, neck and shoulder pain.

In the future may cause  permanent osteo-articular damage in the back and shoulders and skin problems (mainly under the breasts). For for this reasons, certainly you need a breast reduction surgery.

Kind regards

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 174 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.