Trying to find out what policiy various insurance companies have for determining coverage for a breast reduction. Most have some sort of chart for grams. I know it goes by height and weight. Female has a BSA of 2.06
What is the Average Amount of Grams Removed for a Breast Reduction?
Doctor Answers 12
Breast Reduction and Insurance Coverage?
Thank you for the question.
A good estimate for an “average” weight of tissue to be removed for insurance coverage of breast reduction surgery may be 500 g. It would be best for you to check with your specific insurance company for precise information.
Average breast reduction
There is not specific average number that I can quote you becuase this differs for each individual. I have done lifts with almost no breast tissure removal, and my largest reduction was 3.5kg( more than 7 lbs) per side! If I had to guess my average reduction is probably 700-1000 gms per side.
This is because several measurements—not to mention breast characteristics such as density—are needed to determine how much and where to remove breast tissue to meet your goals. Without knowing your existing breast shape, dimensions, and the density of your breast tissue, it would be difficult to make this determination. For example, the same volume of breast tissue will weigh different amounts (measured in ounces or grams) in different people depending on its density. The existing base width of your breast and what you will ultimately want to look like will determine, in many cases, the maximal volume and weight that will need to be removed for the best result.
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Breast reduction and insurance and costs
Probably the average that is "required" for coverage by the insurance carriers is 500grams or a little over two cup sizes. They have other criteria which varies by carrier. Watch my video.
IT is a matter of your INSURANCE
You have received some very good answers to your question. Bottom line is the insurance company dictates the amount of grams required for removal. Some insurance companies use the Schnur scale to calculate your BSA and then reference a chart for grams needed for removal based on the BSA. Some other insurance companies use different scale that is more aggressive than the Schnur scale. It is up to your surgeon to guide you as to whether the require grams is unreasonable for a SAFE AND REASONABLE outcome.
Average amount of grams removed for a breast reduction
For insurance coverage from 300 to 500 grams per side at a minimum. Best to see in person a boarded surgeon who can discuss in detail the issue and show you photos.
From MIAMI DR. B
Breast Reduction Amount
Most insurance companies if not all now do not simply use the 500 gm rule. Since height and weight matter, they use a sliding scale called the Schnur scale. This is based on your Body Surface Area. The heigher the ratio the more breast tissue that needs to be removed. The scale is amount per side.
Precertification is often obtained for breast reduction to see if your plan covers it.
"Average" weight that NEEDS to be removed by a Breast Reduction
For YOUR purposes, it does not really matter how much weight NEEDS to be removed by a Breast Reduction with insurance companies, A,B,C,D or E if your insurance is with company F. In your case, if you want your insurer (F) to partially pay for your Breast Reduction, you and your Plastic surgeon (who agreed to accept whatever company F pays, when it pays...) MUST play by the rules and weights imposed by company F.
Although many companies still mandate removing 500 grams per side, many raised the weight higher while others reverted to a Schnur scale requirement. In the whole, it does not matter. You and your surgeon are bound to respect company F's rules regardless of how onerous or out of place they may be.
Breast Reduction Amount
In actuality, most use 500g, no matter what your size and weight are. Sometimes you ahve to fight with them to cover people under 500g, but as long as you can provide medical documentation to back it up, usually you are OK. I have had coverage on someone who was 5'0 and only had 300grams removed. It just depends on your insurance company. Some never even ask to see the pathology weights after, while others want to see the operating report and weights removed. To be safe and avoid hassle, 500 grams is the magic number.
Schnur table lists the 'recommended' grams for breast reduction
The Schnur table was constructed by a surgeon using historical breast reduction patient data- its clinical validity has been challenged. Even the creator of the Schnur table has lamented its use by insurance companies to restrict payment for this very helpful operation. Based on your BSA- over 697 grams per breast would need to be removed. This is a substantial amount of tissue. A board certified plastic surgeon should be able to tell you if, after the removal of this much breast tissue, you would have a viable and attractive breast. The option to pay out of pocket for breast reduction also exists, and certainly would expedite your breast reduction. Insuracne company approval often takes months, and this procedure is frequently denied.
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.