I am a 38DDD, Would Insurance Cover Breast Reduction? (Photo)

I am 5ft 10 in and weigh 199 lbs.I am a 38ddd and I am having back shoulder and neck pain. I love my breast but cant deal with the pain. I have my first consultation coming up soon. Just wondering what size would my breast be after removing 610grams from eash breast? Average. Judging by the picture do u think I am a good candidate for a breast reduction? And do u think that insurance might cover my surgery?

Doctor Answers 7

Breast Reduction Candidate?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for the question and picture.

Based on your description you may be a good candidate for breast reduction surgery; it may be in your best interest to drop weight first (if that is one of your goals). Unfortunately, there is no way of predicting whether a specific insurance company well cover your procedure.
The best way to obtain insurance coverage for breast reduction surgery involves 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 letter/pictures from your plastic surgeon will help you obtain authorization. Unfortunately, there is no direct correlation between the amount of tissue removed and the ultimate cup size that a patient will wear after breast reduction surgery.

Before undergoing the breast reduction procedure it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.‚Ä®Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

Make sure you're saying a well-trained/experienced board-certified plastic surgeon. Good luck!

Good candidate for breast reduction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Yes, judging from your photo you would be a good candidate.  More importantly however are the medical problems accompanying your large breasts.  If you have pain, chaffing, and have tried good support bras without success, then you should qualify.  It doesn't matter what your plastic surgeon or you think however, it is what the criteria of your insurance company is that determines whether it is covered. Their criteria differs from one insurance company to another.  Removing 610 grams should make you somewhere in the B to C cup range.  Cup size prediction is only a guess. It can vary depending on the circumference of your chest also.  Generally your plastic surgeon will collect your information, examine you, take photos, then send a letter to your insurance company.

Randy Proffitt, MD
Mobile Plastic Surgeon

Questions about being a candidate for a breast reduction as well as insurance issues

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your photos and information is helpful with regard to your questions. Clearly, your breasts are large and significantly asymmetrical and the symptoms that you describe at compatible with your enlarged breast size. Therefore, you could definitely benefit from a breast reduction. Your insurance company would need to be contacted to make sure that the surgery is a covered benefit.

Have your plastic surgeon (do you have one?) evaluate your breasts and then submit the information to your insurance company for authorization.

I am a 38DDD, Would Insurance Cover Breast Reduction? (Photo)

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you could lose 10 to 20 pounds it would help in obtaining insurance coverage as to height vs weight ratios. Otherwise yes I believe you could obtain insurance coverage. 

Breast Reduction Surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

As far as insurance coverage, you would need to check with your insurance company and your plan's coverage criteria.  In many cases, at least 500 cc would need to be removed from each side.  You look like you would be a good candidate, but would need a full examination to know for sure.  You can expect to be reduced several sizes, but we cannot give you exact estimates without seeing you in person.


Good luck.


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX

Insurance Covering Breast Reduction Surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You are most likely a candidate for breast reduction surgery due to your breast size and related pain. However, it will depend on the insurance coverage that you have as policies can vary greatly. Most will want to know what you have already tried such as, physical therapy, good support bras, weight loss, etc. See a board certified plastic surgeon for a consultation and your surgeon should be able to help you obtain approval from your insurance company.

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.