Breast reduction, will OHIP cover my procedure?

Question

I used to be a size 40H and lost 60lbs and my boobs are now a size D and they are saggy and painful with the skin folds. They aren't as big but they are causing me alot of pain. Would it still be covered for a reduction by ohip or would I have to pay out of my pocket?

Leila Kasrai, MD, FRCSC · Answer

If your breasts are causing you pain then OHIP may cover your procedure. The procedure would also make your breasts perkier. Please work with your doctor and plastic surgeon to obtain OHIP coverage.

Gary M. Horndeski, MD · Answer

Hi,The Horndeski Method/The Bellesoma Method is a current technique to lift and/or reduce breasts without using implants or the ugly vertical scars.  The incisions are hidden around the areola and in the inframammary crease. The vertical incision has been completely eliminated. The areola incision heals almost invisibly due to the fact that there is hardly any tension on the closure. With this particular technique, ducts are preserved along with nerve supply maintaining nipple sensation and the ability to breast feed. Because the breast is reshaped internally and is secured to your chest muscles, upper pole fullness is possible without an implant. Attached is a patient who underwent The Horndeski Method/The Bellesoma Method. Please note that her tissue was used to create upper pole fullness and cleavage without any foreign materials (mesh, implants, etc).  Unfortunately, we do not accept insurance for breast reductions.  Dr. Horndeski does not remove enough breast tissue to meet insurance criteria.  Instead, he utilizes the breast tissue to reshape the breast.  It is a proprietary technique that only surgeons that have been trained by me can perform. I hope this helps. Best wishes and kind regards, Dr. Gary Horndeski

Michael J. Weinberg, MD · Answer

Thanks for this question:The coverage of a breast reduction is determined by the Ministry of Health after an application is made by your Plastic Surgeon.Your coverage depends on many factors including your cup size, your BMI and your symptoms. The most significant symptoms are neck and back pain.You will likely get covered but it really depends on the Ministry.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problems your disproportionately large breasts have caused.  Breast reduction tends to be one of the most patient pleasing operations we perform.
Best to check directly with your "insurance entity" to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, the more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. 
   Your first will likely be in person consultation with board-certified plastic surgeons who can demonstrate lots of experience achieving the types of outcomes you will be pleased with. Best wishes.

Breast reduction, will OHIP cover my procedure?

Answers (4)

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