How long does it take to get approved for a breast reduction?

Question

I am a 40 H in bra size and I wanted to know how long would it take to get approved by my insurance and what are the recovery procedures? And if the surgery is done how long after can I start wearing a regular bra again?

Kenneth Hughes, MD · Answer

None of us can predict what decisions insurance companies will make regarding coverage for BR surgery, what documentation will sway their decision, or the length of the approval process. BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered by most medical insurance providers.  If not, they may try to deny you based upon a lot of things such as lack of symptoms, lack of previous medical management, and lack of enough tissue that should be removed. The insurance companies will dictate the amount of tissue to be removed, not the PS.
Read your medical insurance certificate of coverage. Determine what medical information is required for your medical insurance company to issue a pre-authorization or predetermination of benefits for BR surgery. Then seek consultation with a board certified plastic surgeon who can evaluate your medical condition and history, discuss the pros and cons of this surgery as it applies to you, and help you in completing the paperwork required.  The PS who performs you surgery will have his/her own set of post-operative protocols for recovery and the period of time you should wait before wearing a regular bra.

Keith M. Blechman, MD · Answer

Unfortunately there’s no straightforward answer to this question.  We sometimes get approval immediately, and sometimes patients have to appeal for a year.  Every plan is different, and since insurance is regulated by individual states, different rules may be in place depending upon where you are in the country.  Since the introduction of ObamaCare significant cost and responsibilities have been shifted from the insurers on to the patients, and the doctors now have very little influence on decisions, and oftentimes are withheld information.  So what’s most important is knowing that you are the policy holder with a contract between you and your insurance company, so the best way for you to get answers is to personally contact your own insurance company to determine the specifics of your particular plan.  Unfortunately, most doctors offices don’t have the resources to figure this out for you, and the information they’re given by the insurance company is oftentimes unreliable anyway.A visit to a plastic surgeon's office will help you to understand if you're a candidate for the procedure, and what aesthetic and/or functional outcomes are realistic in your particular case.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, always schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Best of luck,
Keith M. Blechman, MD
New York, NY

Daniel Barrett, MD · Answer

Dear jgamiz,The majority of breast reduction patients need one week of downtime. Depending on the work environment (heavy lifting, etc) more time off may be necessary. Patients are encouraged to walk immediately after surgery to avoid blood clots in the legs. I suggest that you follow your plastic surgeon’s post-operative instructions, especially on the level of activity that you can do and your scheduled follow up checkups, for faster and recovery.Every surgeon has a preferred type of bra that they let their patients wear after breast reduction, as this would depend on various factors like the type of surgery performed. You should discuss your concerns with your plastic surgeon and follow his or her advice. Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Scott C. Lindsay, DO · Answer

Thank you for your question.
Once you have a consultation with your surgeon, and the appropriate documentation is sent to your insurance company,   it can take anywhere from 4 to 6 weeks for an approval or denial from them. 
Recovery is different for every patient. Most patients are back at a desk job within 2 weeks. No lifting greater than 10 lbs. or vigorous activity for 3 weeks.  Give your body time to heal and recover from surgery. Best wishes!

Christine Blaine, MD, FACS · Answer

Thank you for your question.  There are no stead fast rules on the turn around time for obtaining an approval for medical necessity coverage of a breast reduction.  Most insurance companies want to see a well documented history of 'failed conservative management' including notes from orthopedic surgeons, chiropractors, physical therapists, internists, and dermatologists attesting to chronic back, neck and shoulder pain or rashes as a result of large and heavy breasts.  Assuming that you have the required documentation and are a true candidate for a medically necessary breast reduction (satisfying the gram amount/weight minimums to be surgically removed) most insurance companies will provide you with a decision (approval or denial) within 14 business days of claim submission with all supplemental documentation as required by your plan.  If you are denied there are options for an appeal.  Your best bet is to schedule an in person consultation and evaluation by a board certified plastic surgeon to discuss your concerns and review your candidacy for a breast reduction.  Recovery is usually pretty simple with patients returning to work within 3-5 days of their procedure.  Patients are generally encouraged to wear a light weight compression surgical bra post-operatively for the first 4-6 weeks, but each surgeon has their own protocol and recommendations based on their experience and training.  I hope that this helps.  I wish you the very best!

Curtis Wong, MD · Answer

usually take at least a month... as the insurance carrier has no motivation to get you approved and on your way.  If you have a high deductible, it may be easier and less stressful to just do this cosmetically where you pay for everything yourself.  My own deductible is $12,500... and if you had this done cosmetically in my practice, it would cost you much much less so that is a plan B for you if you are a marginal candidate for reduction covered by insurance.

William Albright, MD · Answer

Hello jgamiz
Unfortunately insurers vary widely on inclusion / exclusion criteria and timing for prior authorization approval (or denial).  Weeks or even months may be the norm.  You can always try to contact your insurer to verify documents have been received and processed.  
Postoperative recovery regimens are also highly variable.  You should discuss these regimens with your board certified plastic surgeon during your consultation and make sure that he/she answers all of your questions to your satisfaction.  Good luck!
ABPS board certified plastic surgeon

David Azouz, MD, FACS, FRCS(C) · Answer

Approval for a breast reduction is variable.  Some times it can take as little as 4-6 weeks and sometimes it can take longer.  Wearing a regular bra would depend on the plastic surgeon's practice.  Sometimes plastic surgeons have you in a regular bra immediately, other times they recommend not to have underwire bra and some plastic surgeons use compression for a breast reduction.  All of these answers also depend on your skin quality, breast size, need for axillary liposuction and desired final cup size.

Jon Ver Halen, MD, FACS (license suspended) · Answer

Dear Jgamiz,Hello and thank you for your excellent question.  Most insurance carriers will expect you to have a full year's worth of documentation of your symptoms before approving your surgery.  You should check with your insurer directly to see if 1) they will cover your procedure, and 2) under what conditions. You should be evaluated for a No-Vertical-Scar breast reduction technique.  Some people refer to this as the Bellesoma Breast Lift technique. Our technique provides an exceptional breast lift, upper pole fullness, relief from neck and back pain, and no vertical breast lift scar. It uses a woman’s OWN breast tissue to produce an internal suspension technique, without the need for a breast implant. It does not disturb the nipple, areola, or breast glands, so sensation and the ability to lactate is preserved. It uses 3D scanning of your breasts and body to design a procedure specifically designed for YOU, and you alone. Finally, for patients who desire breast enlargement, it can be combined with fat grafting. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!
  
Best,
  
Jon Ver Halen, MD FACS
  
Harvard educated plastic surgeon
  
Texas “Top Doc” 2017, 2018
  
RealSelf100
  
America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 – 2018
  
BeautyAdvisor Top Contributor

Melih Erogul, MD (retired) · Answer

Hi and welcome to our forum!
Each insurance carrier has different criteria for coverage for breast reduction. Some will require symptoms such as breast pain, back and shoulder pain, bra strap grooving, chronic rashes under the breasts and such, others demand a trial of non-surgical options such as breast support and physical therapy, and some won't assure coverage until the weight of the surgical specimen has been received from the laboratory and has been found to exceed a certain weight. 
Just as the criteria vary, response times vary. If it has been exceedingly long, I recommend you call your insurance carrier and complain. They are supposed to be working for you! While you are on the line, ask them for their criteria for coverage for breast reduction.
Recovery after breast reduction is relatively straight forward. You should be able to resume light activities within a few days, moderate activities after one week, and heavy duty activity at one month. A regular bra is usually allowed after 4-6 weeks.
Good luck!
Best wishes...

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