Breast Reduction for DDD?

This is a great question. Insurance companies often have certain requirements in order to approve surgical reductions. For example, documented history of neck and back pain caused from heavy, pendulous breasts, sometimes they require non-medical measures like physical therapy, and a history of rashes underneath the breasts. In addition, some insurance companies require a minimum amount of breast tissue to be removed in the surgery depending on your height and weight. This is known as the Schnur scale. If your insurance does give you pre-approval for surgery, it is possible to make your breasts as small as you desire. Remaining too big sometimes can be challenging as there is usually a minimum amount of breast tissue to be removed to satisfy the reimbursement requirements.

A breast reduction is your best option to reduce the size and shape. Generally speaking, insurance should be able to cover it with back pain, discomfort, and bra strap grooving. If you do not want as much removed as the schnur scale would recommend, the only option would be to perform a cosmetic mastopexy/reduction.

For someone with a large breast size experiencing discomfort due to the size of their breasts ("symptomatic macromastia"), breast reduction surgery may be a solution, especially for addressing pain and physical limitations. Many insurance providers cover the procedure if it's medically necessary, requiring proof of issues like neck, back, or shoulder pain, bra strap grooving, interference with daily activities, and skin irritation. Insurance companies often provide specific guidelines for the amount of tissue that needs to be removed, and this is often based on your body size (body mass index or body surface area). You may also choose not to use your insurance for the procedure. It is helpful to provide "wish pics" as before and afters to help the surgeon better understand your aesthetic goals, since cup size can vary.
It's important to consult with an experienced plastic surgeon who specializes in breast reductions to ensure they understand your goals, help navigate insurance, and discuss potential techniques to minimize risks and scarring while achieving the desired result.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Contact your insurance carrier to determine if a breast reduction is a covered procedure and what is included in criteria for coverage. Requirements for minimum removal amounts vary. You can also forego the insurance companies altogether and pay out of pocket to get the look you are wanting. Visit with a board certified plastic surgeon near you to learn more.

If starting from a DDD cup size, you may only be able to achieve a D cup with standard techniques. If you want to go smaller, you would need a free nipple graft technique that involves removing the nipple-areola, reducing the breast to the desired size without limitation, and then grafting the nipple-areola on the breast.