Breast Reduction After Pregancy

hi i'm a 21-year-old-mother who gave birth over 14-months ago,my problem is that i always had an a-cup breast and during my pregnancy my breast changed to a c-cup and stayed that way. i never felt back pain until my pregnancy and now a year later its still there. hypothetically i drew the conclusion it's my breast after reviewing diffrent stories. because my back,neck and sholders are hurting and my breast is so heavy. do you think my insurance company would cover it even though i'm not a d-cup? (i included a pic) thanks in advance dana321

Doctor Answers 12

Breast reduction by insurance

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You might see a plastic surgeon who can try to estimate how many grams of weight you might have removed.  This will tell you if insurance might provide coverage. 

Typically, Reduction Produces Long-Term Patient Satisfaction

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Your symptoms suggest that you would benefit from breast reduction surgery.This procedure has the potential to improve quality of life and has long-term health benefits as well.

Most patients with breast enlargement complain of difficulty with back pain, shoulder pain, neck pain, rashes, and pain within the breasts themselves.They often have decreased exercise tolerance and as a result, gain weight elsewhere.They have difficulty finding clothes that fit properly and they feel that people stare at them.This adversely impacts their self-esteem, self-image, and self-confidence.

Correction of breast hypertrophy is a life changing experience, symptoms improve, clothing fits properly, exercise tolerance improves, patients lose weight elsewhere and self-esteem improves following this procedure.

Each insurance company has its own criteria for coverage of breast reduction.In some cases, it may not be covered.In other words, it may be a contract exclusion.In most cases, approval of the procedure is dependent upon several variables.Most companies require documentation of symptoms and physical findings.They require a minimal amount of breast tissue removal and they require failure of conservative management.

If you’re considering breast reduction surgery, consultation with a board certified plastic surgeon is appropriate.Your surgeon will be able to evaluate your situation and write a prior authorization letter to your insurance carrier.

Breast Reduction and Insurance Coverage?

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Thank you for the question and picture.

The best place to start would be with a well experienced board-certified plastic surgeon consultation.

Obtaining 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.

Prepare to be persistent but keep in mind that breast reduction surgery is one of the most patient pleasing operations we perform.

Good luck!

Insurance for breast reduction after pregnancy

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It has been our experience that it is difficult to get insurance companies to pay for this.  Each company is different, and have different criteria.  Most want to see a documented history of bra strapping, neck/back pain that is not alleviated by physical therapy, and other criteria.  Often the companies demand a certain amount of breast tissue be removed before they will pay. 

Best to check with your individual insurance company.  Then see your Board Certified Plastic Surgeon.

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

Breast reduction surgery after pregnancy

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Breast reduction is indicated when large breast size causes back and neck pain and irritation of the skin from bra straps or from areas where the breast rubs against other skin. That being said, what your insurance will cover depends on your plan.

I would advise that you wait at least 6 months after you have stopped nursing before considering any procedure on your breasts. You may also want to be sure that you are done having babies. If your breasts have grown this much with one pregnancy, they are likely to grow again with each subsequent one. Pregnancies after breast reduction might cause your breasts to grow again.

Elizabeth Slass Lee, MD
Bay Area Plastic Surgeon
4.8 out of 5 stars 56 reviews

Breast Reduction after Pregnancy

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You must consult with your Physician in regards to the neck, back and shoulder pain. It has to be documented in order for the insurance company to consider paying for it. The Insurance company will usually base there incision on a Height to Weight ratio, and how much volume your Plastic Surgeon feels that he will need to remove. Some insurance companies require that a minimum amount be removed in order to justify payment. I hope this answers your question.

Foad Nahai, MD
Atlanta Plastic Surgeon

Breast reduction and insurance coverage

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Hi dana321 - All insurance companies are different concerning their policy on covering a breast reduction. Have your plastic surgeon look at your specific insurance plan to determine whether or not you meet the criteria. This can be grams of tissue removed or simply pre-authorization with photos and medical letters. However, from your photo is appears as though you may not be a candidate for a breast reduction, but again it's difficult to determine from a photo only. Good luck!

Insurance coverage for breast reduction

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The best answer for this question will come from your individual insurance company. They all have different criteria. You should call them first to find out what their criteria are and then proceed with what they might require ahead of time, ex. chiropracter visit, physical therapy, family doctor evaluation, etc.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 37 reviews

Breast Reduction insurance coverage

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Dear Dana,

EVERY single insurance company writes multiples different types of policies which are different.

The FIRST thing you should do is READ the fine print in your benefits book (or ask your HR person) if YOUR policy even covers / has "Breast Reduction Benefits". Many do not. If your does not - you will have to pay out of pocket.

If your policy DOES have such benefits, find out which Plastic surgeons in your area "participate" with your particular policy. If a surgeon does not "participate", he/she will charge you directly for the operation since they are NEVER going to be paid by your insurer.

Once you have a list of a few such surgeons, check them against their listings at the American Society of Plastic Surgeons and see them in consultation. They WILL know the answer to your "do you think my insurance company would cover it even though i'm not a d-cup?" question.

From what I hear from my friends in Florida and based on what we encounter in Tennessee, I seriously doubt they will pay for your surgery. What they will do is mandate that your surgeon remove an amount of breast tissue which will leave you with an A cup breast.

See the doctors near you and they will advise you best.

Peter A. Aldea, MD
Memphis Plastic Surgeon

A breast reduction requires a large amount of weight reduction to be covered by Insurance.

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From the photos you included with your question, I doubt that you have enough breast tissue to have a large enough reduction to give you much relief of your symptoms and to be covered by your insurance. If enough breast tissue is removed to obtain coverage I think you will feel you are too small. But there is certainly no harm in checking. See a board certified plastic surgeon, get an estimate as to how much could be removed and ask your surgeon to submit it to your insurance company for pre operative approval.

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 17 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.