Would I be a good candidate for insurance breast reduction? (United Health Care)

Hello! I am a twenty-two year old with a bra size of 32 E (or DDD). I weigh 120 pounds and I am 4 11" in height. (And before gaining some weight I was 110 with a bra size of 28 G.) I have had major back pain. When I was 16 and saw a chiropractor, it was documented that I had a partially collapsed disk in my lower back and now back pain has became worse recently, (shoulder/neck pain resulting in headaches). I'd love any information on reducing breast weight myself/medical reduction advise.

Doctor Answers 10

Am I a Candidate for Breast Reduction?

Thank you for the question and congratulations on your decision to undergo #breastreduction. It appears that you do have a small frame and would definitely benefit from a #breastreduction. The symptoms that you are experiencing are quite typical for a woman with large breasts. In addition to relieving the physical discomfort, we find that breast reduction also improves self image, allows for participation in various physical activities and it's easier to find clothes that fit.

There are different procedures available to reduce large breasts and women that elect to have #mammoplasty, also will require a lift. The lift is part of the procedure at no extra cost. A #lift is necessary to ensure proper placement of the #nipples and can allow for areola reduction if needed. 

In general when the excessive breast size causes functional problems, #insurance will generally pay for #breastreduction 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. 

The best advise I can give you is to schedule a consultation with a Board Certified plastic surgeon who will be qualified to evaluate your current breast shape and volume. They will also be able to explain all of your options. Good luck!

Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

Will insurance cover a breast reduction?

#Breast reduction coverage varies depending on what insurance carrier you have. We submit photos as well as medical history to your carrier and do everything possible to get it covered. If it is not, we do offer excellent financing through several companies and even in house if you do not qualify. I usually do #breast reduction surgery as an outpatient and the recovery is usually 2weeks from all activity.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.4 out of 5 stars 27 reviews

Breast Reduction/Breast lift / Breast Augmentation/ Breast Implants/ Anatomic Gummy Bear Implants/ Silicone Implants

I appreciate your question.

I specialize in Breast Reductions and Restorative Breast Surgery.

From your description, it sounds like you would be an excellent candidate for breast reduction surgery.

The best way to assess and give true advice would be an in-person exam.

Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon



Breast Reductions and Insurance Coverage


The reality is that insurance companies are making it harder and harder to cover breast reductions, lowering reimbursements to the surgeon, delaying reimbursements, or denying coverage entirely to out of network providers.  This forces you to have surgery with a surgeon that they pick for you, and it still might take a year or more to mount a case.  Instead, I recommend that we all come to the same conclusion that insurance companies are already really adopting, that breast reduction is mostly cosmetic, regardless of whether or not the patient has symptoms of her large breasts. You want a pretty result with fine scars, and so you want a surgeon that focuses on aesthetic surgery of the breast; chances are he doesn't take insurance any longer.  It would be much quicker to get a surgical loan from one of the three main lending companies: Care Credit, Prosper, and Alpheon. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

Am I a candidate for breast reduction?

Thank you for your question and you are a good candidate for this procedure.  This will change and improve the quality of your life and help reduce the pain and suffering in your back and neck. Due to your age a reduction may affect your ability to nurse and you may be giving this up for your comfort but you will need to decide if this is worth the cost.  You will have to go through several months of conservative treatment and jump through several hoops to get this approved.  Each insurance company is different but with patience and persistence you will most likely get approved.  I would visit with a board certified plastic surgeon who can help you through the process.

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

Breast reduction weight is based on Schnur table recommendations for insurance patients

Based on your height and weight, a reduction of about 260 grams per breast would be required from most insurance providers that use the Schnur table guidelines. Consult with a plastic surgeon to see if this amount of reduction is reasonable for your individual anatomy.

Insurance breast reduction?

Thank you for your question.  Judging only by your history, symptoms, and small frame size, you're likely an excellent candidate for breast reduction. Each insurer has their own policy requirements and exclusions, and policies can differ markedly within the same company. Many plans now require a documentation of symptoms over a specific time before they will pre-authorize the procedure. An experienced plastic surgeon can assist you in navigating the insurance requirements. In a complete consultation, your local plastic surgeon can also provide you with the necessary information to make an informed decision. Over the past 20 years, many of my patients have described their breast reduction as a 'life-changing' procedure. I hope that yours is as well. Best of luck to you.

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

Will my insurance company pay for my breast reduction?

Many insurance companies will cover the expense of breast reduction surgery. A plastic surgeon can help you by sending a photos and a letter describing your symptoms because of your large breasts to the medical director of the company for pre-approval of your surgery. The company will decide if you meet the criteria for payment. Good luck to you. For more information on this and similar topics, I recommend a plastic surgery Q&A book like "The Scoop On Breasts: A Plastic Surgeon Busts the Myths."

Ted Eisenberg, DO, FACOS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 59 reviews

Breast reduction

You are the ideal candidate for a breast reduction. You will improve your quality of life and the aesthetic appearance of your breasts. 

Breast reduction

You are a very good candidate for breast reduction. Consult with breast specialists in your area. The reduction will be both a functional and cosmetic improvement.

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 40 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.