Breast Reduction for Petite Patient with 36DD Breast?

I'm 27 years old, 5'0" and I weigh 130 lbs. I am considering getting a Breast reduction, currently my breast size is 36DD.

I am having lots trouble with breathing, sleeping, neck and back pain and grooving in my shoulders from bra straps. I also have had a problem with a sebaceous cyst under my right breast. The cyst had to be surgically removed after rupturing.

Am I a good candidate for this surgery? And if so, How can I get my horizon HMO blue cross blue shield to cover the surgery?

Doctor Answers 11

Breast Reduction Candidate?

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Thank you for the question.

Based on the description, you may be an excellent candidate for breast reduction surgeon.  It is one of the most patient pleasing operation we perform.

To begin the process of insurance coverage, you will need to have  your primary care physician refer you to a plastic surgeon in the HMO  you are insured through. Your plastic surgeon will then be able to help you obtain authorization for the perceived. Be prepared to be persistent.

Best wishes.

Breast Reduction for a Petite Frame

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Based on the description of your body habitus as well as your symptoms, you would seem to be a good candidate for breast reduction surgery. It is quite reasonable that you would have such complaints of back, neck, and shoulder pain from the DD cup size that you carry on a small frame. Each insurance carrier will have a discrete and written inclusion criterion for authorizing breast reduction surgery. Contact your carrier to find out the specific requirements.

Leo Keegan, MD
Manhattan Plastic Surgeon

Breast reduction

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Horizon blue cross requires a lot of paper work including physical therapy, othropedic evaluation and a letter from your primary are physician.

David L. Abramson, MD
New York Plastic Surgeon

Final bra size after a reduction

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Breast reduction is a popular and effective way to remove tissue that may be causing pain and symptoms and contour the shape of your breast. Be sure that you're working with a board-certified plastic surgeon who has a great deal of experience in breast reduction surgery so that the specialist can review the different surgical options and help you decide which one is best for you and can help you choose a surgery that will balance your frame.
This is especially important in small patients to help create a harmonious result.

Breast reduction surgery and insurance approval

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FIrst, if you are in an HMO and you want insurance to pay for it, you will have to go to a surgeon that is a member of the insurance panel. Second, you will probably need documentation with doctor's notes regarding your symptoms.

Breast reduction will relieve symptoms.

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1) Good news: You sound like a great candidate for breast reduction surgery, and it will help a lot with your symptoms.

2) Bad news: Insurance companies usually pay only if a very large amount of breast tissue is removed. I doubt that you will meet their criteria. But your plastic surgeon can send a letter asking for pre-determination.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Breast Reduction Coverage & Indications

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You certainly sound like a good candidate for a reduction.  You should discuss your symtoms with your physician.  Many HMOs require a referral from your primary physician.  If you are denied, there is probably an appeal process that you can undertake.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Breast reduction for 36DD

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Based on your physical description and symptoms, you certainly sound like an excellent breast reduction candidate and one for whom the procedure should be considered "medically necessary."  Keep fighting for coverage, and if they continue to resist, save the money to have it done. 

Breast reduction

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You are a good candidate for breast reduction (reduction mammoplasty). Do not be upset if your initial request for pre-certification is denied by your insurance company. Be sure to ask for an appeal; if there is another denial, ask for an appeal with the physician reviewer being a plastic surgeon. These are hurdles they often put in your way to try to discourage you from continuing the process. Your plastic surgeon should be familiar with this and help you through the appeals. This will only work if the insurance company does pay under certain circumstances. There are come carriers that do not reimburse under any circumstances, but again you should find this out right away.

Theodore Katz, MD, FACS
Philadelphia Plastic Surgeon

Best of luck with insurance approval for breast reduction

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It seems that you will benefit from breast reduction. Insurance approval is a completely story. Your physician will be able to help you to get the approval. It helps to have track records for all your complaints documented by your primary care physician. At the end the insurance company might deny it even after giving an authorization. It sounds ridiculous but this is the reality of the insurance world we live in!

Best of luck!

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.