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

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?

Doctor Answers 7

With G cup breasts and scoliosis, you should get insurance coverage for breast reduction.

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This is an article I wrote that you may find helpful:

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1)  Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2)  Very big reductions (like from an F cup to a C cup) will usually be covered.

3)  Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4)  Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5)  DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6)  Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7)  Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8)  Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9)  Don't give up. If the first request is denied, demand an appeal.

10)  If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

Manhattan Plastic Surgeon

Insurance coverage for breast reduction with scoliosis

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Having scoliosis will not make it more likely for the insurance company to cover a breast reduction surgery.  If they think your back pain is due to the scoliosis instead of the heavy breasts they may deem the reduction not a medical necessity.  Certainly the large breasts may exacerbate your back pain initiated by the scoliosis.  The insurance company is more likely to consider coverage for breast reduction surgery if the amount of breast tissue to be removed is significant.  It sounds like this is the case in your situation, but it will depend on the insurance company's own criteria and needs for demonstration of medical necessity.

Marialyn Sardo, MD
La Jolla Plastic Surgeon
4.0 out of 5 stars 6 reviews

Breast reduction

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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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

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

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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. 

Breast reduction coverage and scoliosis

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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.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Insurance coverage for breast reduction with scoliosis

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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.

Breast Reduction Coverage and Scoliosis

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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 “hoops”  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.

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.