Breast Reduction Consideration. Should I Look Into Insurance? Do I Go to a General Doc or PS First?

I've hated my large breast my whole. I am 32 years old, 123 lbs and a 34DDD (naturally).. My breasts are horrendous, droopy and un-shapely against my small frame. I have poor posture and sore shoulders. I'm seriously considering a breast reduction but would like first consider insurance. I've read the requirements (aetna HMO) and they are very intimidating. Should I even attempt insurance involvement? Do I go to a general doctor first or plastic surgeon? Bite the bullet and pay?

Doctor Answers 7

A reduction will likely be money very well spent.

Coverage for reduction varies depending on the insurance company.  If it's covered, be prepared to jump through a lot of hoops.  They will do their best to wear you and your surgeon down with their often absurd requirements.

If it's not covered, consider paying out of pocket.  A breast reduction is less expensive than a used Honda and it will likely last a lifetime. 

Seattle Plastic Surgeon
5.0 out of 5 stars 72 reviews

Breast reduction

You should definitely try to have insurance cover the procedure is you fit the proper  criteria.  Whether you need to see your primary care doctor first and then get a referral or wether you can go straight to the plastic surgeon will depend on your insurance requirements.  If you call,up your HMO, they will tell you how to get started. Having your HMO approve the surgery may take some persistence on your part, but if you are an appropriate candidate, you can probably be successful in obtaining the coverage.  Good luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast Reduction and HMO

Contact your insurance company and see if they have a participating Board Certified Plastic Surgeon that you can see directly or if they require you to see an internist first. Insurance companies have different requirements. Based on your weight and breast size, you should have no problem qualifying for the procedure IF it is a covered procedure under your policy. Ask to see before and after pictures of the surgeon's actual patients. Good luck.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 75 reviews

Breast reduction

I recommend you visit with a board certified plastic surgeon in your area to learn more about your options.   Their office staff can find out for you if a breast reduction is a covered benefit in your insurance plan.  Best of luck.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 210 reviews

Approach for breast reduction surgery

Thank you for the question. These are common questions when it comes to breast reduction surgery. If you have insurance and you are symptomatic; i.e. have neck, back and shoulder pain and you have documentation by your primary care physician, then I think you should try the insurance route. The plastic surgeon will submit all the information along with his examination findings. The insurance may approve the surgery or reject it. If the surgery was denied they will tell why it was denied. 

If you decide to pay for it, then you have to find a board certified plastic surgeon, this can be from the American Society of Plastic Surgery directory. Get a consultation, look at before and after photos and determine what you want. I hope that helps you.

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

Breast Reduction Consideration. Should I Look Into Insurance?

Although most insurance carriers tell you they cover breast reduction surgery, many have very strict limits on what exactly they cover. It's best if you have been seeing your primary care physician for awhile about your symptoms and he has that recorded in your medical history. But ultimately you need to see an experienced plastic surgeon for an evaluation. That doctor will interface with your insurance carrier for you to see if your particular circumstance is covered. Most of us see so many reduction patients that have no insurance coverage that we have cosmetic fees established for those patients so you can know ahead of time what the costs might be and can budget appropriately. This is an operation that has uniformly happy patients. Good Luck.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast Reduction Through Insurance?

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery.

It is one of the most patient pleasing operations we perform.
Based on your description you may be a good candidate for breast reduction surgery.  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.

Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.
Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 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.