Do I need to lose weight for a breast reduction and get it covered by insurance?

Question

I am 19yo with a 38DDD breast size. I'm also 5’1 and weigh 170-180. Growing up I developed serious back pain and I was also bullied through middle school for having big breasts at a young age causing me to have chronic depression and a really low self esteem. Would I need to lose weight in order to get a breast reduction? Would insurance cover part or the whole procedure?

Derek Fletcher, MD · Answer

It depends on the insurance plan you have. Most plans require documentation of neck, back or shoulder pain that has failed conservative measures (physical therapy). Having a history of recurrent rashes that require treatment helps as well. Breast size does not reliably change with weight loss (especially in your age group) so planning to lose weight is not typically required. Especially for women whose breast size interferes with exercise and makes weight loss difficult. 
Set up an appointment with your primary care provider to discuss your breast symptoms. You will likely need to complete physical therapy. If you have breast rashes, request a prescription for treatment. Social distress and self esteem are important parts of your history, make sure you tell your provider about this part of your history. Most insurance companies will cover your breast reduction if you meet these criteria.

Camille Cash, MD · Answer

When considering breast reduction it is best to be at a healthy weight, but sometimes that is not always possible.  I encourage you to meet with a board certified plastic surgeon near you to discuss your interest in the procedure.  You can contact your insurance carrier to see if breast reduction is a covered benefit and what criteria are needed for coverage as it varies carrier to carrier.

Irena Karanetz, MD · Answer

Hi,
Thank you for the question. 
Based on what you are describing, it does sound that you have large/heavy breasts causing physical symptoms, and breast reduction may be an option for you. However, it is difficult to tell without seeing the photos and/or in person consultation. During breast reduction surgery, excess breast tissue is removed, the breast is lifted and nipple/areola is typically made smaller. It is easiest to think of breast reduction as including the breast lift. 
Schnur Sliding Scale is a scale used by many insurance companies as a guideline for how much breast tissue should be removed in order to improve your physical symptoms. In addition, most insurances in order to approve the surgery, will require for 2-3 letters of medical necessity (from your chiropractor, primary doctor, OBGYN, Dermatologist, etc) demonstrating that your physical symptoms due to large breasts are not improving with conservative management. 
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  Each Surgeon will have their own protocol when it comes to surgery and BMI.  Insurances are all different and require different guidelines.  I would suggest seeing a Board Certified Plastic Surgeon in person to evaluate you, discuss your options, gather the insurance information and make a plan.  Best of luck to you.

Scott C. Lindsay, DO · Answer

Hello and thank you for your question.
You want to be at a healthy, stable weight prior to surgery. Check with your Insurance company to see if this is a covered benefit for you. Many Insurance companies cover this surgery, when medically necessary. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

Do I need to lose weight for a breast reduction and get it covered by insurance?

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Do I need to lose weight for a breast reduction and get it covered by insurance?

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