BEST BET IS A PREAUTHORIZATION LETTER
Hello and good luck. Every insurance has some parameters they look for . Your best bet is for your surgeon to write a preauthorization letter including the weight of the planned removal and your body surface area on what is called a Schnur graph. From the pictures, I would say you have a good chance for your insurance to help you in covering
Breast reduction coverage by insurance
If a doctor deems a patient's back and shoulder pain is likely due to the weight of her large breasts, and would improve with a breast reduction, then the procedure would be considered medical necessary, and in theory should be covered by insurance. However, in practice this is not always the case. Some plans will go right ahead and pre-authorize the surgery, while others will require a fight and want documentation regarding attempts at physical therapy and other non-surgical approaches to first manage the pain. I've even seen some plans with fine print that specifically exclude coverage for a breast reduction. It's best to visit a plastic surgeon certified by the American Board of Plastic Surgery who will properly evaluate you in person. This is the first step to the process of getting a breast reduction covered. Stay positive, and if your doctor deems your surgery to be medically necessary, hopefully your insurance company will be willing to cooperate with you to get your surgery covered.
Best of luck,
Keith M. Blechman, MD
New York, NY
Breast Reduction Indications
Breast reduction is a very common procedure in plastic surgery that improves both form and function. For patients with a normal BMI and large breasts, the functional deficits would need to be documented including neck and back pain, rashes, difficulty fitting into bras and any treatments for these issues. Amount of estimated breast tissue removal is vital and typically anything over 500 gm is significant. A patient who is young, healthy and not smoking with a normal BMI would be an excellent candidate for this procedure which will decrease the size, reshape and lift the breast.
25 y/o w/ DDD/E breasts seeking advice!
Thank you for the question. Based on your description and pictures, you may be an excellent candidate for breast reduction surgery. This operation tends to be one of the most patient pleasing operations we perform.
“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.
Patients considering breast reduction surgery should also consider the potential downsides (risks/complications) associated with the procedure as well. Poor scarring, for example may be associated with the procedure. Additional surgery may be necessary in the short or longer term for a multitude of reasons.
When the time is right, I suggest that you seek consultation with well experienced plastic surgeons who can demonstrate significant experience achieving the types of outcomes you would be pleased with. Ultimately, careful selection of your plastic surgeon will be the most important decision you make.
To this end, 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 (dedicated to breast reduction surgery concerns), helps. Best wishes.
You are an excellent candidate for a bilateral breast reduction. I would recommend going to a board certified plastic surgeon and having he or she do an exam and try and get it authorized. You look to me like you have about 400-500 grams to remove. you would be about a small C after removing that much though. Make sure you see lots of pics and you are happy and comfortable with your surgeon. You want to make sure they are board certified.
Hello,You are young with relatively small breasts compared to those truly debilitated by their macromastia. You should focus on the surgeon instead of insurance. You want a skilled and experienced expert to give you smaller breasts that are also pretty - these folks are ABPS certified/ASAPS member surgeons who specialize in cosmetic breast surgery. Chances are they don't take insurance anyway. There are some great financing programs that might make it affordable for you. Best of luck!
25 y/o w/ DDD/E breasts seeking advice
Thanks for your question and pictures. The ability to get insurance to cover a breast reduction is not always dependent on if your surgeon determines it to be medically necessary. Some plans have specific criteria that need to be met in order for the procedure to be covered. These criteria include weight of breast tissue removed based on your height and weight, attempts at physical therapy, and others. Each plan is different. It would be best for you to have an exam by a board certified plastic surgeon and then start the process through his/her office to get approval for surgery. Good luck!