Breast Reduction for Petite Patient with 36DD Breast?

Question

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?

Otto Joseph Placik, MD · Answer

It sounds as if you are an excellent candidate for a breast reduction. The problem will be convincing your insurance company. First discuss this with your primary care giver. He/She will have to review your medical history and will be the first step in determining whether the HMO will approve the procedure. In some instances they may require a course of physical therapy. They will be your best advocate in being approved for the procedure

Scott C. Lindsay, DO · Answer

Hello and thank you for your question.
It sounds like you are a good candidate for breast reduction surgery. Contact your insurance company to find out  if this is a covered benefit under your policy and what the requirements are. Best wishes!

Tom J. Pousti, MD · Answer

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.

Leo Keegan, MD · Answer

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.

David L. Abramson, MD · Answer

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

Pat Pazmino, MD, FACS · Answer

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.

Steven Wallach, MD · Answer

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.

Hisham Seify, MD, PhD, FACS · Answer

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!

George J. Beraka, MD (retired) · Answer

Hi.
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.

John Whitt, MD (retired) · Answer

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.

Breast Reduction for Petite Patient with 36DD Breast?

Answers (12)

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