Breast Reduction for DDD?

Thank you for sharing your story—what you're experiencing is very real, and you're not alone. As a plastic surgeon who performs breast reductions frequently, I’ve seen many patients with similar proportions and concerns who found life-changing relief after surgery, even with smaller tissue removal amounts than what insurance typically requires.
Our practice actually made the decision to stop working with insurance for breast reductions, and here’s why: we found that insurance guidelines often don't reflect individual needs or quality-of-life concerns. Instead, we now work directly with patients, which has given them more autonomy to make decisions based on their goals—not arbitrary gram thresholds. This has allowed us to focus on surgical planning that prioritizes both physical relief and aesthetic preferences, like going smaller than a B cup if desired.

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

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.

Thank you for your question. Breast reduction surgery can decrease the pain and limitations you're experiencing during activities by removing a substantial amount of breast tissue. Insurance companies often require proof that the surgery is necessary, which includes documentation of symptoms like back, neck, and shoulder pain, skin irritation, and limitations on physical activity. While some insurers specify a minimum amount of tissue (like 500 grams per breast), your desire to reduce significantly increases the likelihood of meeting these requirements. However, significant reductions may involve more extensive incisions, leading to more noticeable scars. Your surgeon will explain incision options and scar management techniques. Also, be aware that nipple sensation may change, and future breastfeeding could be affected due to the extent of tissue removal.

Hello,Most insurance companies do not have a specific weight requirement ( ie 500 gms) when it comes to qualifying for insurance coverage. A commonly used tool is the Schnur formula, which takes into account your body surface area when calculating specific resection weight requirements. Other important factors to consider include the severity of your chronic neck, back and shoulder pain, as well as strap marks across the shoulders and skin irritation under the breasts. I find it very helpful for my patients to get letters of support from other treating health care providers (GPs, gynecologists, orthopedists, physical therapists ). As always, you should consult with a plastic surgeon certified by the American Board of Plastic Surgery who has extensive experience with breast reduction surgery and is familiar with the process. I hope this helps.

Hi IHaveQuestionsABC. Unfortunately, it is very difficult for insurance to cover breast reductions regardless of being a DD or DDD. Over the past few years, insurance companies have significantly decreased who gets approved and if the surgery is approved, the waiting interval for surgery can be long. You usually have to try other modalities and have documentation of referrals for physical therapy, orthopedic consultations, chiropractic treatments, etc. You also do not have as much flexibility when it comes to choosing your surgeon. I would recommend reaching out to your insurance company to see what their process entails. In regards to the size that you are wanting, there are limitations of going too small. We want to make sure that the nipple areolar complex region has adequate blood flow in order to keep it alive. That being said, size is also dependent on your anatomy but I would suggest working with your surgeon to set expectations and discuss the risks and potential complications. Good Luck on your surgical journey!

Thank you for your questions. Most insurances use a sort of "sliding scale" for qualification for breast reduction. So it is a factor of your height and weight relative to your breast size. So, based on those criteria, you might qualify but it can be difficult. You would need to see a plastic surgeon who takes your insurance to submit the procedure for approval. If you do not want to worry about approval and want to focus on the cosmetic outcome and achieving your goals, then I would advise seeing a local plastic surgeon of your choice for an elective cosmetic surgery consult. Then you and your surgeon can focus on you rather than meeting the rules of some insurance company.
Best of luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

At size 32, each 100 grams removed corresponds to 1 cup size change. 500 gram removal would result in 5 cup size reduction and you would end up a size A, which would not be appropriate for your body. Insurance companies operate under the belief that only weight removal can relieve neck, back and shoulder pain. There is an alternative technique called The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This technique is not covered by insurance.

Best Wishes,

Gary Horndeski, M.D.