Breast Reduction with insurance BCBS Federal. Is 500 grams too much?

Hello and thank you for your question.
It is difficult to answer you question with out photos. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best of luck!

None of us can predict what decisions insurance companies will make regarding coverage for BR surgery or what documentation will sway their decision. 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 medical insurance.  If not, your medical insurance may try to deny you based upon a lot of things such as weight, lack of symptoms, lack of previous medical management, and lack of enough tissue that should be removed. 
Read your BCBS Federal medical insurance certificate of coverage. Determine what medical information is required for BCBS Federal 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, discuss the pros and cons of this surgery as it applies to you, determine the amount of tissue to be removed, and help you in completing the paperwork required by your medical insurance company.  (Take all documentation you have accumulated from your PCP to your board certified PS's consultation appointment.)

At size 38 D, each 200 grams removed corresponds to 1 cup size change.  If you removed 500 grams, that would take you down 2 1/2 cup sizes to between an A and B, which may be too small for you.  The technique I recommend is The Bellesoma Method.  This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.  This technique is not covered by insurance since you will not need or desire to remove 500 grams.Best Wishes,Gary Horndeski, M.D.

Most insurance companies require a minimum of 500 grams needs to be removed in order for insurance to cover. Without pictures it is hard to give an opinion. Your best bet is to consult with a board certified plastic surgeon who will be able to discuss all your options. Good luck.

When considering breast reduction, in addition to establishing a case for medical necessity, there are also requirements for resection weight (when covered by insurance). This may be a standard "500 gm per side" stipulation or a more variable standard based upon body surface area/Schnur scale. It is important to realize that these weight requirements can occasionally exceed your goals for size reduction. Insurance coverage is contingent on these requirements being met, thus cosmetic concerns become secondary(i.e. cup size goals).
With regards to your specific question, there are reduction limits which are independent of insurance requirements. A certain amount of tissue must be maintained in order to preserve the vascularity to the nipple areolar complex. The larger and more ptotic the breast, the more difficult it is to reach a significantly smaller size post op (a full B from a D is not unrealistic).
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Top 100
RealSelf Hall of Fame

many insurance companies require a certain minimal amount of tissue removal to pay for it.  Without photos it is impossible to know or even guess the appropriate amount of breast tissue removal in your case.  You do want to be sure that the required breast tissue to be removed will not make your breast TOO small.  You should have your surgeon address this issue.

Dear TLynn1962,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Hi and
welcome to our forum!
From the
surgical standpoint, you presently appear to have symptoms attributable to your
breasts. Under these circumstances, you would benefit from breast reduction. Patients commonly complain of neck pain, shoulder pain, back pain, bra strap grooving, or chronic rashes beneath the breasts.  From the
insurance standpoint, different companies have different criteria. Some will
require a surgical specimen to be of a certain weight, most will accept
symptoms, some require a course of preoperative physical therapy.
Your primary care physician and orthopedic surgeon both feel that your pain is not of neurologic origin, but is due to the weight of the breasts. Documentation of symptoms and letters from these physicians may alter or eliminate the 500 gram minimum restriction imposed by the insurance company. Communicate with your insurance carrier. An in-person examination is required to determine if there is sufficient volume.
I
recommend a consultation with a board certified plastic surgeon. After
evaluation / examination, a letter requesting preauthorization can be submitted
to your insurance carrier.
Best
wishes...

Thank you for the question. Based on your description you may be an excellent candidate for breast reduction surgery.   “Typical” patients who present for breast reduction surgery are women who have disproportionately large breasts, causing problems such as neck/back/shoulder discomfort, postural changes, bra strap grooving, skin irritation/rashes under the breasts, and/or difficulty with activities of daily living and/or exercise etc. There may be both physical as well as psychosocial “stress” caused by the disproportionately large breasts.
Reducing breast tissue mass and elevating the breasts on the chest wall tend to improve or alleviate many of the symptoms associated with the disproportionately large breasts.
 
   It will be important that you communicate your goals clearly with your (carefully selected) plastic surgeon and make sure that you have realistic expectations prior to proceeding with any type of surgery. In regards to breast size desired, also communicate carefully. In my practice the use of goal pictures are helpful in this regard; a discussion of cup size can be confusing and imprecise.   Therefore, I would not suggest that you communicate your goals and/or base your satisfaction with the outcome of surgery on achieving a specific cup size.  
With the goal of improving communication with my patients I find the use of photographs of “goal” pictures (and breasts that are too big or too small) very helpful; more helpful than the words “natural” or "proportionate” or "B cup" etc., which can mean different things to different people.  
Again, my best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as discussed above. Working together you will come up with a good plan to achieve your goals. 
 Best wishes for an outcome that you will be very pleased with.