I am 5'1" 183 pounds my BMI is 38. I want breast reduction to improve my posture, self esteem and reduce back pain.

First, you need to ask your insurance company what their criteria are for approval.  It is likely that you will need to lose weight to lower your BMI and decrease you potential for complications.

Obese and morbidly obese BMI categories are associated with tremendous surgical and anesthetic risk for breast reduction patients. Surgical breast reduction is not a cure for obesity. It can temporarily take tissue off, but this is not a permanent adjustment to your total body mass and fat will re grow according to your metabolism and calorie intake after the surgery. HOWEVER you do need a breast reduction. Your loose tissue in the upper body is very debilitating and difficult and can make women of any BMI feel overweight. I think you are right that surgery would help you. You must address your main health problem with obesity separately and before your surgery. When you get out of the obese category and have stabilized your weight, you can then undergo surgery to address the loose skin and uncomfortable tissue. Only you can adjust your lifestyle in ways that will lower your BMI. There are a lot of resources out there and you can do it! I hope this helps.

Every insurance is different but as a trend over the past 20 years they have progressively restricted paying for Breast Reduction, increased the number of hurdles you have to go through to get approval and have drastically reduced the doctors' reimbursement for the operation in an effort to lower the numbers of these operations. I can tell you that obesity is a criteria the insurers look at and they wither will not cover the operation until you are at a lower BMI or they mandate removal of much greater amounts of breast tissue thereby turning a Breast Reduction to a near Mastectomy leaving you with not much of a breast. I wiukd start by checking your benefit book or contact yiur insurance and find out which Plastic surgeons in your area accept your insurance and see several of them. You will quickly learn your options and be able to make a good decision. Good luckPeter Aldea MD

To get a full discussion of the procedure requires quite a bit of time and thus a consultation and examination, it can't happen in this forum. At your BMI you are at a very high anesthesia risk, I know my board certified anesthesiologists would balk at elective surgery for you unless you were admitted to a hospital for one to two nights for respiratory observation. Liposuction at your weight would be a total waste of your money as any results would be unnoticeable. Finally, the majority of insurance companies will not pay for this surgery in obese patients because in some cases simple weight loss will reduce the breasts.