Will insurance pay for me a Breast reduction?

I'm 5'2 weight 160 lbs after having my 3rd csection and tubes tied I'm wanting a breast reduction and my cup size is 4 ddd my breast get black heads and big bumps on them the skin is very saggy near the breast that sits next to my arm and my breast hand very long considering I'm 27 yrs old I have alot of back and neck aches and shoulder aches so I'm wondering if insurance will find it medically necessary

Doctor Answers 7

Will insurance pay for me a Breast reduction?

Thank you for the question. Based on your description, you may be an excellent candidate for breast reduction surgery. This operation tends to be one of the most patient pleasing operations to perform.

Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, 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. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. Also, prepare to be persistent when dealing with health insurance companies. 

In regards to the outcome of the breast reduction surgery, the most important decision you make will be careful selection of your plastic surgeon. I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.

Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. ***Ask to SEE lots of examples of their work AND preferably speak/see patients who have had similar procedures done.

I hope this, and the attached link, helps. Best wishes.

Insurance and breast reduction

You need to ask your insurance company what their criteria are for approval of a breast reduction. Based upon that, you can then see a surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Will insurance pay for my breast reduction?

Thank you for your questions and without photos it is difficult to tell just how problematic your breasts are.  It sounds like you are a good candidate for the procedure and you will need to see a board certified plastic surgeon who does a lot of this kind of procedures.  It may take time and effort and trials of conservative treatment before it is approved but each insurance company has its own criteria for approval.  Your surgeon can help you through the process.

John D. Smoot, MD
La Jolla Plastic Surgeon
5.0 out of 5 stars 12 reviews

Will insurance pay for me a Breast reduction?

Insurance covers breast reduction if you meet their criteria. the only way to find out would be see a plastic surgeon for a consultation and examination. The surgeon will then communicate with the insurance company to see if they will authorize your surgery. It is an extremely gratifying procedure so I hope you get good news.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Breast red

Health insurance often covers breast reduction surgery because of the medical problems associated with larger breasts. You can call your company before you schedule a consultation to see if coverage will be considered. Your plastic surgeon can help you by sending a letter of your symptoms and pictures to the medical director of the company for pre- approval of your surgery. The company will decide if you meet their criteria for payment. Hope this information helps and good luck. For more information on this and similar topics, I recommend a plastic surgery Q&A book like "The Scoop On Breasts: A Plastic Surgeon Busts the Myths."

Ted Eisenberg, DO, FACOS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 59 reviews

Insurance and Breast Reduction

Thank you for your question, it is a very common one on RealSelf.

The first thing you need to do is look at your insurance policy or call your insurance company to see if it's a covered benefit.  Also see what the criteria are for coverage (for instance, some companies will only cover it if you've tried physical therapy for your back pain).  If it is a covered benefit, then find plastic surgeons in your network, and schedule consultations with them to discuss you options.  Your plastic surgeon will help guide you through the rest of the process.


Dr. Dan Krochmal

MAE Plastic Surgery

Northbrook, IL

Daniel Krochmal, MD
Chicago General Surgeon
5.0 out of 5 stars 17 reviews

Insurance and Breast Reduction

See a board certified plastic surgeon with experience in breast reduction.  He or she will examine you, do some measurements and estimate the amount of tissue that will be removed.  If your policy does not specifically exclude breast reduction (many do and people don't realize that) it sounds like you have a good chance of being covered with the symptoms you describe.  Good luck, Jane

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.