Insurance companies should pay for breast reduction based on symptoms of breast heaviness, breast pain, shoulder and neck pain, bra strap grooving. There is no arbitrary amount of breast tissue to be removed to achieve these results, and some women may not lose a lot of weight in their breasts if they are mostly glandular with less fat. The picture shown would be an indication for a breast reduction if you felt symptoms mentioned above or if you just wanted smaller breasts. However, getting insurance to pay is difficult because they sometimes make you jump through hoops to postpone or avoiding paying for the surgery. In my practice, I write a letter with photos to the insurance company, indicating the medical reasons why the procedure is indicated. It can be helpful if you have some documentation from your regular doctor that you have been complaining about symptoms for some time, and that you did try to lose weight or lost weight with no improvement with you symptoms.Some insurance companies will then authorize the procedure, but some simply will not, and it seems arbitrary, based on current ASPS guidelines for breast reduction. Google asps breast reduction insurance coverageand you will find a PDF position paper on this issue as well as sample appeal letters.