Insurance requiremenets for breast reduction can be tricky
Some insurance companies, like yours, have a flat requirement of 500 grams for "approval." That does not take into account whether you are 5'5", 5'7" , 5'11' or what your body weight is. From what you tell us, your breasts are not that big (between D and DD. medium frame)
The problem for your surgeon is that, during surgery, he/she may find that your shape and size would be great with a 400 gram reduction. Your surgeon is then faced with a terrible option: leave it at 400 grams (and trigger nonpayment by the insurance company), but give you what he/she thinks is a great size and shape. The other option is to try to please the insurance company by getting to 500 grams and risking giving you breasts that are too small or with a poor shape.
I suggest you go your kitchen/grocery store and figure out exactly what 500 grams (slightly over one pound) looks like. You can then try to imagine removing 500 grams from your own breasts and see if that is still a desirable size. Ask your surgeon to help you in this decision ahead of time.
The last thing you want is a surgeon that feels obligated to cut more out than is indicated simply to comply with an insurance company policy.
500 gram breast reduction will make you too small.
Hi! Unfortunately, a 500 gram breast reduction for each of your breasts will leave you with a B cup, and maybe even a small B cup. So I don't recommend it.
Breast Reduction is a complicated procedure that is best done by those with the most training and experience. It is very difficult to determine the resultant cup size and shape based solely on the number of grams that are removed from your breast to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast reduction and lift surgeries, including different approaches, techniques and even fat transfer and implant choices if you are lacking superior breast fullness.
This is because several measurements—not to mention breast characteristics such as density—are needed to determine how much and where to remove breast tissue to meet your goals. Without knowing your existing breast shape, dimensions, and the density of your breast tissue, it would be difficult to make this determination. For example, the same volume of breast tissue will weigh different amounts (measured in ounces or grams) in different people depending on its density. The existing base width of your breast and what you will ultimately want to look like will determine, in many cases, the maximal volume and weight that will need to be removed for the best result.
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Removal of 500 Grams on Each Side Would Most Likely Result in a B or C Cup for You
Patients often speak
in terms of cup size. Unfortunately, cup size is not always helpful because
manufacturers of bras label their products differently and women don’t wear
their bras the same way. For many women their bra size becomes their breast
size even though they may not be directly related. For these reasons,
discussions of cup size can often lead to confusion.
In addition, it’s
not unusual for insurance carriers to require that minimal amounts of breast
tissue be removed during breast reduction. This amount varies from insurance
company to insurance company. In many cases, these weight criteria may be in direct
conflict with the patient’s aesthetic goals.
situations arise, it may be necessary for patients to make compromises between
their desired size and insurance payment. In your case, the removal of 500
grams on each side would most likely result in a B or C cup. Again, this
depends upon each individual patient’s interpretation of cup size.
Breast Reduction of 500 Grams from DD Cup Breasts
The 500 gram rule is a standard that is used by most insurance carriers to grant precertification status on breast reductions. This is a rough guide. Usually symptomatic large breasts will need at least 500 gms and many times more is taken. You should have a frank discussion with your Plastic Surgeon over what size you want to be and if that can be accomplished within the confines of insurance reimbursement.
Each insurance company is different with what they require to "authorize" the breast reduction surgery through insurance. I write a letter and send photos of the patient when trying to get authorization (I am sure most plastic surgeons do this as well). Also getting supporting letters from other doctors who can document that you have had neck, back and shoulder pain and/or rashes due to the large breasts. Supporting documentation is usually very helpful. It sounds like you have supporting document from your ortho surgeon and PT. As you can see from the various answers, no one really knows what cup size you will be after removing 500 grams. You need to speak to your plastic surgeon to get a "general idea" and also make the decision to proceed or not.
How much tissue to remove during a breast reduction
Patients today have many great options to effectively reduce and contour their breasts. In our practice, we work closely with patients to understand what their goals are and how much breast tissue is necessary to alleviate any pain symptoms that they may have and to obtain the look that they are looking for. Before the surgery, we can sometimes give an estimate as to how much tissue will be removed. However, there is no exact way to determine how much breast tissue will be resected. Be sure that you review your insurance policy and how closely with your plastic surgeon about your goals. Remember that these are the breasts that you will live with aunt is more important for you to obtain the results that you are looking for then to satisfy a meaningless number for an insurance company.
Without examining you it is very difficult to say whehter or not a 500 gm reduction is not only suitable for you but will provide you with a reasonable volume of tissue to provide you with a nice looking breast.
500gm breast reduction sounds too much for you
Based on your current bra size, height and weight (but not on an actual examination), I recommend that 500gm will reduce your breast to C cup or smaller. Your plastic surgeon may give you a better idea, based on an examination. If your orthopedic, PT and plastic surgeons all think that reduction of smaller amounts will improve your shoulder symptoms, then you should appeal the decision of your insurance company.
As to your question about firmness and roundness after surgery, the reduced breast will be a modified version of your current breast. If it is made of firm dense glandular tissue, it will be firmer than one composed of mostly loose fat. I'm sure your surgeon will do his or her best to give you a nice result. You will also get a helpful breast lift when reduction is done.
Breast reduction and cup size
The old requirement from insurance co. was to remove 500gm (454gm=1lb) of breast tissue no matter what height or weight the patient was. Most insurance co. now base their "weight" requirement on the patient's BSA (body surface area). Obviously a patient who is 5'2" tall and has a D cup and one who is 6' tall and a D cup represent different weights. A 500gm reduction in the taller person will lead to a B/C cup, in the shorter one might mean a mastectomy. Although cup size is an estimate, a cup size is about 150-200gm or cc of water. So, a 500gm reduction will give you a B/C cup. This might or might not be proportional to your frame. You will need to discuss this with your board certified plastic surgeon. Best of luck.