Will Having Scoliosis Make Me a Better Candidate for Insurance Helping with Breast Reduction?

Question

I'm currently 22, 189lbs, 5'4" and wear a size 38G. I have had scoliosis since I was a kid, so I'm no stranger to back pain. I'm wondering if my having scoliosis would factor into my insurance approving a breast reduction?

Ronald J. Edelson, MD · Answer

Insurance companies consider the following factors when determining whether they will cover breast reduction surgery: physical symptoms such as back and neck pain, photos submitted by your plastic surgeon and the estimated amount of breast tissue which will removed from each breast. They usually require 400 - 500 grams removed from each breast. It is worth mentioning to them that you have scoliosis but the preauthorization will likely be made on the three factors I have just mentioned. Good luck.

Darryl J. Blinski, MD · Answer

The back deformity will not determine whether the insurance with approve the breast reduction. It could even help. Best to see in person a boarded PS in your area to write your insurance company a letter of pre determination of benefits.

Steven Wallach, MD · Answer

You have to check with your insurance company regarding coverage for the procedure. Often back issues documented that have not improved with conservative measurres may be an indication to approve the surgery if your breasts are very large.

Robert L. Kraft, MD, FACS · Answer

Yes, If you can establish that the back condition is exacerbated by the size of your breasts.  Generally a G cup reduction would be approved and any supporting documentation that your orthopedist could supply would be of assistance in the preauthorization process.

Tom J. Pousti, MD · Answer

Thank you for the question. 

	The history of scoliosis may or may not help you in your efforts to obtain insurance company authorization for the breast reduction surgery.  If, for example, your spine doctor  can write a letter stating  that the breast reduction surgery may be helpful in alleviating some of your symptoms  this may be helpful.

	Unfortunately,  insurance companies are making patients jump through  more and more &ldquo;hoops&rdquo;  before they authorize breast reduction surgery. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better.  

	Documentation and letter/pictures from your plastic surgeon as well will help you obtain authorization. Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.

	Best wishes.

Will Having Scoliosis Make Me a Better Candidate for Insurance Helping with Breast Reduction?

Answers (5)