I'm 25 and I have big boobs and by back hurts does Ohio cover to get them downsized?

Doctor Answers 6

Will insurance cover your 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.


Orange County Plastic Surgeon
4.9 out of 5 stars 150 reviews

OHIP coverage

Yes, it is possible for OHIP to cover your breast reduction. Work with your GP or plastic surgeon to determine if a breast reduction would be medically advisable for you. 

Leila Kasrai, MD, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 66 reviews

Breast reduction

You would have to check with your insurance company to see what the criteria are for coverage of the procedure.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 26 reviews

OHIP coverage for Breast Reduction in Ontario

In Ontario, OHIP can cover breast reduction procedures.  For this to happen, you need to be referred by a family doctor to a plastic surgeon who will then see you, assess you and if found to be a suitable candidate, he/she will then submit an application to OHIP (OHIP doesn't automatically cover reductions).  Most (but not all) patients get the approval.  Only after the approval was given will the surgery be scheduled.

There is a limitation to what an OHIP breast reduction covers.  It covers removal of breast tissue.  Most plastic surgeons perform additional liposuction / cosmetic component which is not OHIP covered, and some plastic surgeons perform on cosmetic (non-OHIP) breast reductions.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 449 reviews

Breast reduction

Hello,

It sounds like you may be a good candidate for breast reduction. I recommend getting a consultation with a plastic surgeon. Most insurance companies cover that procedure.

All the best,

Dr. Blagg

Austin, TX

Ross Blagg, MD
Austin Physician
5.0 out of 5 stars 17 reviews

Breast reduction surgery candidate?

I am sorry to hear about the problems you are experiencing secondary to breast hypertrophy; based on your description you may be an excellent candidate for breast reduction surgery at some point.  “Official” recommendations of course would necessitate in-person consultation.



Breast reduction surgery is one of the most patient pleasing operations we perform. By removing “excess” breast tissue, adipose tissue, and breast skin this operation reduces AND lifts the breasts to a higher position on the chest wall (in other words, the breasts are "automatically" lifted when a breast reduction is performed). By doing so, patients often find improvement no problem man distill your daddy loves it in neck, back, and shoulder discomfort and find it easier to form their activities of daily living and exercise.



Unfortunately, online consultants will not be able to predict, with any degree of certainty/accuracy, whether your insurance company will authorize the procedure.  Either direct contact with your insurance company or with the help of your plastic surgeons office, will give you more precise information.  Generally speaking, obtaining insurance coverage for breast reduction surgery will likely involve some “hoops” to jump through.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.



This documentation and letters/pictures from your plastic surgeon will help you obtain authorization. Prepare to be persistent when dealing with health insurance companies.


When the time is right, seek consultation with well-trained/experienced board-certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.

I hope this, and the attached link, helps. Best wishes as you work towards your goals.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,460 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.