Breast Reduction Requirements in British Columbia?

Question

I live in British Columbia and have an appointment to see about a breast reduction. I get a lot of pain in my upper back and on one side of my ribs. I've had larger breasts all my life. I'm 5-6 and weigh 155. I'm a D cup. Will I be covered in British Columbia for a reduction? I do have indents in my shoulders and was approved in Ontario a year ago BUT moved to BC before the surgery. I would like to go to a large B or small C.

Stan M. Valnicek, MD · Answer

Thank you for your question.  In BC the requirements are for symptomatic hypertrophy as quoted below directly from the current Medical Services Plan guidelines:
"Reduction Mammoplasty is a benefit for female patients only, where there is significant associated symptomatology such as intertrigo, neck or back pain or shoulder grooving. Ptosis and/or size are not sufficient grounds for MSP coverage of reduction mammoplasty. Mastopexy is not normally covered by MSP. "
Since you have pain and grooving, you are a candidate.  Pre-approval from the government is not required anymore.  Because the criteria are subjective, there is an agreed minimum weight removal of around 270 gm per side (1 cup) in order to prevent the equivalent of a breast lift (without significant reduction for symptom control) being done at public expense.  Again - because you wish to go down 1-2 cups in size, you qualify for the surgery under the Medical Services Plan.

Sheila S. Nazarian, MD · Answer

Honestly, I don't know if the rules in BC are the same as the states. Here, only certain insurance companies will cover the procedure and only if certain criteria are met -- usually having to do with the amount of tissue removed. When you have your consultation, your surgeon should have a better idea of the rules/restrictions in Canada. Best, Dr. Nazarian

Scott C. Sattler, MD, FACS · Answer

There are some excellent plastic surgeons in BC that can answer this question for you. In the US, our insurance companies typically adhere to resection weight guidelines that are based on a patient's height and weight - the so called 'Schnur Table' is often cited by insurance company coverage guidelines as a rule of thumb for PER BREAST resection requirements.

Susan MacLennan, MD · Answer

Hello and thanks for your question. We see patients from BC in our practice and we do write a letter to BC Health in advance of surgery. We generally mention bra size, symptoms the patient is having such as back,neck and shoulder pain, shoulder grooves, as well as height and weight.From BC Healthlink website:" If you are thinking about having a breast reduction, ask your doctor if your provincial health plan covers the costs. Your provincial health plan may cover some or all of the costs of		  breast reduction surgery if surgery is being done to relieve back pain, skin		  problems, or other medical problems caused by large or heavy breasts. Surgery being done solely to change		  the appearance of the breasts is typically not covered, because it is not considered a medically		  necessary procedure when done for this reason."Please consult with an experienced surgeon in your area, and s/he can help determine if you meet criteria in BC.Best wishes-

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