38yr old female with 42DDD breast. Am I eligible for a reduction surgery and could insurance cover it?

Hello, thank you for your question. Usually with shoulder pain and discomfort due to large breasts, insurance will cover, however it can be a longer process to the claim and get pre approval for the surgery. If you are ok to wait for it and they do cover it then that would be in your interest.

Hello and thank you for your question.
You seem to be a good candidate for breast reduction surgery, as long as you are at a healthy BMI. Contact you insurance company to see if this is a covered benefit for you and what the guidelines are.
Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

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.

Best Wishes,

Gary Horndeski, M.D.

Common symptoms of large breasts are back, neck, and shoulder pain, shoulder grooving from bra straps, rashes underneath your breasts, and limitation of activities. So, you are having symptoms related to large breasts and would be a great candidate for breast reduction surgery. Insurance companies have multiple criteria when assessing whether they would approve breast reduction surgery. In addition to symptoms, they may want to exclude other causes of your pain and ensure that you have tried everything besides surgery for relief. That may include seeing a physical therapist, chiropractor, or orthopedist; getting xrays of the neck and back; getting custom support bras; and/or trying anti-rash creams. They may also want proof that a significant reduction will occur. They will often ask your plastic surgeon to estimate the amount of reduction and compare it to standard tables. The most common is the Schnur scale, which calculates the amount of reduction based on your height and weight. Unfortunately, the criteria differs between insurance companies, so it is best to check with your insurance to see if it will be approved.

Dear kaladj83,
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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

From your description it sounds like you would benefit from breast reduction surgery. This procedure would remove excess breast tissue as well as excess skin. The nipple position is also corrected as part of the surgery. In order to determine if your insurance will provide coverage you need to speak to them if it is a benefit of your policy as well as the criteria that must be met in order for coverage to be approved.

Without pictures it is difficult to say. Best to ask a board certified plastic surgeon . If you have 500 grams or more to remove from each breast , insurance can sometime cover the surgery.

Good luck

Andrew Cohen

Large breasts can cause bra strap grooving, neck pain, and rashes under the breasts. You may benefit from breast reduction surgery if you experience these symptoms, though it is difficult to say without examining you. A breast reduction is generally an outpatient procedure that can often be done under IV sedation. Breast reductions are often covered by insurance, if you meet the specific criteria required by your insurance company. Your plastic surgeon can examine you and discuss your symptoms and goals to determine if a breast reduction is an appropriate procedure for you.

Hi and welcome to our forum!
Breast reduction is both cosmetic and functional, as the procedure often alleviates neck pain, shoulder pain, back pain, bra strap grooving, and chronic rashes beneath the breasts due to their added weight. The reduction procedure is most often performed to regain proper body proportion.
Bra size is an extremely inaccurate measurement of breast size. There is no standardization in the manufacturing industry. One brand's "C" is another's "D". In addition, many individuals wear the wrong size bra.
Your candidacy for surgery requires consideration of many factors. BMI provides information regarding the safety and efficacy of breast reduction. Body mass index equals weight in kg / square of height in meters). You can find BMI calculators on the internet. If your BMI is greater than 30, the cosmetic result will not be optimal. If your BMI is greater than 35, your operative risk will rise. Weight loss through diet and exercise is recommended. If not achievable, a bariatric procedure (such as a gastric sleeve) will result in significant weight loss.
From the surgical standpoint, you presently appear to have symptoms attributable to your breasts. Under these circumstances, you would benefit from breast reduction. It is best and safest to have a BMI of less than 30.
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.
The Schnur scale is utilized by some carriers. It is used in evaluating a patient’s medical requirements when considering breast reduction surgery. It compares the patient’s body surface area by the weight of breast tissue to be removed in surgery. If a patient’s body surface area and removed breast tissue weight are below the 22nd percentile, the surgery is considered to be a cosmetic procedure and is unlikely to be approved by a health insurance company. Alternately, if body surface area and removed breast tissue weight are above the 22nd percentile, the procedure has met the required criteria to be considered medically necessary. Details of this calculation can be gleaned from the internet.
I recommend a consultation with a board-certified plastic surgeon. After evaluation / examination, a letter requesting preauthorization can be submitted to your insurance carrier.
It may be wise to contact your insurance carrier and request their criteria for breast reduction.
Best wishes...