21 years old. 36M bra size. 5'7" and 180 pounds. Am I eligible for a reduction and are there other options? (Photo)

Question

I've had pretty large breasts pretty much since I was in middle school, and I never had a problem with them. But over the last 2 years, my breasts have gone from a 36H to my current 36M and possibly still growing. They are extremely heavy to carry to the point where my back and shoulders start to hurt after standing for only a few minutes. I've tried losing weight, but my breasts didn't go down in size at all, and they make even the simplest exercises difficult.

Miguel Delgado, MD · Answer

You should be a candidate for breast reduction surgery, however it would depend on what type of insurance you have. Some policies exclude breast reduction all together. I would suggest that you see a Board Certified Plastic Surgeon for a consultation. The surgeon would be able to help you get authorization for surgery if it is a covered procedure. Good luck!

Larry S. Nichter, MD, MS, FACS · Answer

From your description it seems as if you are a good candidate for breast reduction. Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses

Jonathan Amspacher, MD · Answer

From your pictures it looks as though you would be an excellent candidate for breast reduction. I think that most insurances would consider you as a candidate if your insurance does cover the procedure at all.   Some individuals can get relief from neck and back pain through targeted physical therapy and exercises but in your situation it looks as though you should combine exercise with surgery.  A breast reduction may not cure all of your symptoms but it would likely give you a high percentage of relief.  There are some informational videos to help you learn more about breast reduction below.

Stuart A. Linder, MD, FACS · Answer

A breast reduction is certainly your best option to remove the enormous amount of excessive tissue causing your symptoms

C. Bob Basu, MD, MPH, FACS · Answer

You could be a candidate for breast reduction, but it will depend on your insurance policy.  Every insurance plan has their own unique criteria on whether they will 
cover a breast reduction. More and more, we are seeing plans where a 
breast reduction is not a covered benefit. If it is a covered benefit, 
some insurance plans set a minimum required amount of tissue to be 
remove in order to met their threshold for coverage. Some set the amount
 in relation to your BMI (height and weight). Others require extensive 
medical records documenting neck pain, back pain, and history of rashes.
 The other alternative is to opt for a breast reduction as a self-pay 
option. Start by visiting with a board certified plastic surgeon to 
learn more about your options.Best wishes,Dr. BasuHouston, TX

Tom J. Pousti, MD · Answer

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.

Once you have chosen your plastic surgeon carefully, it will be important for you to communicate her goals carefully as well. In my practice, I asked patients to use as many “visual aids”, such as goal photographs, during the communication process. Avoid the use of subjective terms; for example, "C or D cup” and/or “ as small as possible"… these terms can be confusing, since they may mean different things to different people. Once you have communicated your goals, your chosen plastic surgeon will be able to  provide you with a more precise plan, including specific technique to be utilized.

I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.

Mark A. Brzezienski, MS, MD, FACS · Answer

I am not sure what you mean by eligible, but you seem like a good candidate.  It appears that you have virginal hypertrophy of the breasts.  Your board certified plastic surgeon can help you weed through the health care insurance requirements.  Integrate your primary care physician into the process. Your surgeon will want to be sure that you are in good health...and your insurance company will want to understand why your complaints and why your large breast are a healthcare problem for you.Your plastic surgeon can explain the surgical mechanics of breast reduction and how your breast size and shape will be altered by the process.  You can review photos so that you understand the scar pattern.  Be sure to ask about restrictions and the surgeon's habit for follow-up.  Breast reductions are outpatient surgeries.

Christine Sullivan, MD (retired) · Answer

It sounds as though you would be a good candidate for a breast reduction. You would need to contact your insurance provider to determine if a breast reduction is a covered  benefit within your specific plan.  You always have to option to pay out of pocket. In my experience breast reduction surgery has made a big difference for my patients.  Best of luck!

Laura A. Sudarsky, MD (retired) · Answer

Based on your photos, bra size, height and weight, you would be a good candidate for breast reduction. Seek a consultation with a board certified plastic surgeon for a complete evaluation.

21 years old. 36M bra size. 5'7" and 180 pounds. Am I eligible for a reduction and are there other options? (Photo)

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