I am a 38D in bra size. I am 24 5'6" and weigh 160. I have back problems. I am wondering if a breast reduction is something I should consider and if Blue Cross Blue Shield Insurance will cover it. I have a hard time finding comfortable bras that support well because of this size.
Is a Breast Reducttion Right for Me? 38D
Doctor Answers 10
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.
Breast Reduction Candidate?
Thank you for the question.
Based on your description you may be a good candidate for breast reduction surgery; it Is one of the most patient pleasing operations we perform.
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 saying a well-trained/experienced board-certified plastic surgeon. Good luck!
Options for slightly enlarged breasts
You should meet with a surgeon to discuss if you are a candidate and meet the criteria for breast reduction. Other options such as liposuction may be an alternative for mild degrees of breast overgrowth with less scarring, recovery AND expense.
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Breast reductions may or may not be covered by insurance
Insurance companies are all different in how they determine coverage of a breast reduction. For example, many Blue Cross plans require a certain amount of tissue to be removed based upon your weight. For some Aetna plans, photos are required along with supporting documentation from several physicians claiming that the large breast size is a cause of neck and back pain. So, the best way to determine whether or not you insurance plant will cover your breast reduction is to look at the exact requirements in your plan. Then, go to your plastic surgeon and review this with him/her to talk about how small you want to be. Typically, only extremely large, pendulous breasts get covered for a breast reduction. However, it never hurts to ask!
Is breast redustion right for me?
This will depend on several factors. Your reduction will have to be determined medically necessary. You will need evidence to back that up for example back, neck, or shoulder pain, indentations from your bra straps, skin irritation underneath your breasts, restriction of physical activity due to the weight and size of your breasts, etc. It will also depend on the amount of breast tissue that is removed. Every insurance is different, but you can always check with your specific insurance to see what they will potentially cover. If they won't cover the procedure, depending on which procedure exactly is done, the price can range anywhere from $5,000-$8,000. This will also vary depending on which surgeon you go to and the area that you are in.
If you have symptoms of back pain and neck pain related to your large breasts, then a reduction may help improve your symptoms. AS for insurance you should check with your company to see if they would cover it.
Breast reduction and back pain
One simple test to see if a breast reduction will help your back pain is to cradle your breasts in your arms when you have the pain and see if the pain goes away. While weight of the resected breasts is often a relative if not absolute criterion of insurance coverage, it reality it is the physical signs and symptoms that should be relieved. Whatever you can do to document the pain and its subsequent relieve will help in making a case.
Insurance May Cover
Breast reductions can be covered by insurance. It takes pre-approval through the Blue Cross process. First, you should seek evaluation of your back through your primary care or a back specialist. After that, seek out a board-certified plastic surgeon who can review your history, perform an exam and forward the necessary information to your insurance company. You can then proceed with your plans based on your insurance companies response. If your insurance company denies the surgery, you can proceed privately to achieve your goals.
38D Breast Reduction
You are on the borderline for whether or not a breast reduction would be covered by insurance. You would have to be willing to go to a B cup in order to have any chance. You should seek a consultation with a board-certified plastic surgeon in your area who should be able to assist you.
38D likely won't be a reduction covered by insurance
At 160 pounds, a 38D isn't that big so it would be unlikely that insurance would cover a reduction especially since they generally require about a pound removed per side. It doesn't mean you can't have a nice reduction, just that it will not be paid for by insurance.
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.