Breast Reduction & Insurance Coverage When Overweight?

Question

Hello! I am 20 years old 5'6 and 20 lbs above my ideal weight. I have lost 60 pounds over the last 18 months and I am still in the same bra size. I am wearing an E cup but I am probably bigger. I am just wondering what is the likelihood my insurance will cover it. I live in Quebec and all I know is they require 250 grams removed from each breast, I have no doubts in my mind I need more than that removed from each. Just wondering if my weight will cause me to be rejected anyways. Thanks Lisa

David Stoker, MD · Answer

Most insurance companies use a formula to set a minimum weight that must be removed from the breasts, based on your height and weight, for the insurance company to cover your surgery costs.  Check with your plastic surgeon for the specifics regarding your policy.  Good luck.

Vincent N. Zubowicz, MD · Answer

Different insurance companies have the varying conditions when deciding whether or not to cover breast reduction. Overweight patients are sometimes required to try weight loss prior to approval of the procedure. You can call your broker to find out the specifics of your policy.

Tom J. Pousti, MD · Answer

Based on your description, it sounds like you may be an excellent candidate for breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.  It will be in your best interests, regardless of health insurance coverage concerns, to achieve a long-term stable weight prior to proceeding.

	Also, based on your description, removal of 250 g should not be a problem. However, predicting what a specific health insurance company's  response will be would simply be speculation by online consultants.

	 Seek consultation with board-certified plastic surgeons. Ask to see lots of examples of their work.  Make sure you understand the potential risks/complications associated with breast reduction surgery as well.

	 Best wishes.

C. Bob Basu, MD, MPH, FACS · Answer

Every insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.
	Best wishes,

	Dr. Basu
	Houston, TX

Steven Wallach, MD · Answer

You need to go for an exam to be properly evaluated to determine whether you are a candidate for reduction. Then you have to follow-up with you insurance company.

Breast Reduction & Insurance Coverage When Overweight?

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Answer: Insurance coverage for your breast reduction

Answer: Insurance coverage for your breast reduction

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Answer: Breast reduction and insurance

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Breast Reduction & Insurance Coverage When Overweight?

Answers (5)

Answer: Insurance coverage for your breast reduction

Answer: Insurance coverage for your breast reduction

Answer: Breast reduction and insurance

Answer: Breast reduction and insurance

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.