On Medicaid, breasts are different sizes and shapes. Am I eligible for reduction or corrective breast surgery? (photos)

Question

Age 34 Married 15 yrs 2 children Non smoker Occasionally drink 5'2 190lbs Breasts have been asymmetrical since age 12 Grooves in shoulder Dark marks on shoulders and back Irritation under breasts Back pain/spasms Neck pain Wears a bra 24/7

Kenneth Hughes, MD · Answer

Based upon your photos of breast size and asymmetry, and your description of irritation under breasts, and grooves in shoulders and back, you would be a good candidate for breast reduction.  
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 insurance company 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 MEDICAID insurance certificate of coverage. Determine what medical information is required for your insurance provider 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 insurance provider. 
Kenneth Hughes, MD, Board Certified Plastic Surgeon
Los Angeles, CA

On Medicaid, breasts are different sizes and shapes. Am I eligible for reduction or corrective breast surgery? (photos)

Answers (1)

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