Do I qualify for a Breast Reduction even though I'm overweight for my height?

Hello I am 18 years and old and was wondering if I'd be eligible for a breast reduction. I am 5ft tall, and weigh 175lbs. I know that I am overweight but i have been trying to lose weight for atleast a year now have either gained muscle, or maintained weight. I can no longer exercise as of right now due to the severity of pain i am in from my breasts

Doctor Answers 8

BBR

Yes you should be able to have this procedure covered.  Nomograms for breast reduction surgery take height and weight into account.  In your case, you should have at least about 400 gm removed from each breast for it to be covered.  This means you should have at least a D cup breast which is the usual scenario.  Best wishes, Dr. T. 

Insurance for a BR?

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation 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. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive.

Do I qualify for a Breast Reduction even though I'm overweight for my height?

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. Based on your description, it sounds like you may be an excellent candidate for the procedure at some point.  


Best to check directly with your insurance company or entity to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, the more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.


This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. 


Also, prepare to be persistent when dealing with health insurance companies. I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.

Can I Have Breast Reduction Surgery if I Am Overweight?

Being overweight doesn't disqualify you from having breast reduction surgery. I suggest meeting with several local Board Certified plastic surgeons for in-person examinations to determine the best option for you. Best wishes.

Karen Singer, MD
Tampa Plastic Surgeon
4.0 out of 5 stars 5 reviews

Scarless breast reduction

At your age and given the height and weight numbers, you may want to look into the liposuction only operation. Something I will always recommed for women befor child bearing. Find a board-certified plastic surgeon in your area that does this operation and see if it makes sense. 

Sherwood Baxt, MD
Paramus Plastic Surgeon
3.8 out of 5 stars 25 reviews

Do I qualify for a Breast Reduction even though I'm overweight for my height?

Best to seek in person opinions from only boarded private practice PSs in your area of Florida.

Insurance

There are several criteria for a patient to meet before under going a breast reduction.  Most are based on the type of insurance that you have.  A board certified sugeon and their insurance coordiantor should be able to tell you fairly quickly if you are a candidate from an insurance stand point.  Other things to consider at your age is the potential to NOT be able to breast feed in the future and the risk of scarring.  Good Luck.  

Adrian Smith, MD
Jackson Plastic Surgeon
5.0 out of 5 stars 4 reviews

I'm Overweight and Wondering if I Can Still Have a Breast Reduction #breastreduction

  • Being overweight doesn't mean that you aren't a candidate for a breast reduction. 
  • In fact, I've had a number of patients who have lost a lot of weight after their breast reductions. 
  • Many of these women couldn't comfortably exercise prior to their breast reductions due to the size of their breasts. 
  • Definitely meet with a board certified (ASPS) plastic surgeon to be evaluated. 

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.