200g from each breast not enough?

Question

Insurance approved my surgeon’s request that 200g from each breast can be removed and I scheduled surgery for June 11! I didn’t know how much that was until I did some research, but now that really doesn’t seem like enough. I have a pre-op appointment the week before my surgery. Is this issue something that I can bring up at that appointment? Should I bring in desired breast reduction pictures and bras? I’m terrified that I will end up around the same size I am now only with scarring!

Miguel Delgado, MD · Answer

Your concerns are understandable, schedule another consultation with your surgeon to discuss your issue. Be sure to see before and after pictures of the surgeons patients. Show your surgeon what outcome you are anticipating by pictures of his/her patients or bring in your own pictures. Good luck.

Stephanie Peng, MD · Answer

Hi there, thanks for your question. Generally speaking, your insurance company will require a minimum amount of breast tissue to be removed, so it's still considered an "insurance" surgery if your plastic surgeon takes more than the required amount.  If you are worried 200 grams isn't enough to make the change you're hoping for, touch base with your surgeon. It's vital to clearly establish your desires before the actual surgery. One question to ask yourself is, "What's worse, to wake up a touch too big, or a touch too small?" Unfortunately, we surgeons cannot ask you while you're asleep during surgery!  Good luck!

Ted Eisenberg, DO, FACOS, FAACS · Answer

You have reasonable questions which you should address with your surgeon now. In general 200gms is about a cup size difference. Seeing your surgeon's pictures of women with similar measurements to you might be helpful.Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

Curtis Wong, MD · Answer

but you can certainly talk your surgeon into being more aggressive to remove more tissue during your procedure.  My patients tell me to either taken the minimum to meet the insurance guidelines and stay as large as possible, do my procedure in the routine manner and usually end up being a D or large C cup, or to be aggressive to remove as much as possible and get down to a C- or B+.  Make sure you surgeon knows what you want before the procedure is done and if you will be struggling to meet 200 grams from each side, you simply have to accept the outcome from removing the insurance minimums.

Susan Buenaventura, MD, FACS · Answer

Surgeons are not restricted to removing a certain gm amount of breast tissue by insurance companies.   They often have a minimum amount that must be removed.  I would request a second consultation to discuss how much will be removed and the size you want to be. Better to ask all your questions up front and go into surgery feeling confident!

Andrew T. Cohen, MD, FACS · Answer

Best  to show some pictures to your surgeon so that you and he or she can have a good idea about the size you want.  Go to a board certified plastic surgeon for the best results and make sure that they have a lot of pictures to show you . Good luck!

Kenneth R. Francis, MD, FACS · Answer

Dear roorahrah,It is likely that your surgeon submitted that 200g as a minimum weight to be removed for insurance approval for your breast reduction surgery.  He/she should discuss with you the goal for your final breast size and then an estimate of weight to be removed can more closely be predicted.  Good luck!

Tom J. Pousti, MD · Answer

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.
As you can imagine, much will depend on your current breast size (cup sizes can be quite arbitrary…) and goals.  Generally speaking, I would consider a 200 gram reduction a relatively small reduction.
If I were seeing you in consultation, I would ask to look at your goal photographs; after doing so, I would be able to help you with a prediction of what you might expect in terms of anticipated weight of tissue removed. Keep in mind however that there is no specific/reliable correlation between the amount of tissue removed and cup sizes achieved. With the goal of improving communication with my patients I find the use of photographs of “goal” pictures (and breasts that are too big or too small) very helpful. I have found that the use of words such as “natural” or “C or D cup” means different things to different people and therefore prove unhelpful. Again, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
In your case, given the concerns, I would suggest that you spend more time communicating your goals directly with your plastic surgeon, prior to the day of surgery. Ultimately, you will  want to feel comfortable that your plastic surgeon has a significant/demonstrable experience achieving the types of outcomes you will be pleased with. You will also want to feel comfortable about your both on the same page when it comes to desired outcome.  Again, careful communication is key.
 Best wishes.

Richard Zinn, MBChB, MMED, FRACS · Answer

Hi there,

This is a good question and an issue I often try to discuss with my patients.

I seldom quote a volume, size or weight guarantee on a breast reduction.  I aim more for a specific size cup and this also differs between women according to density of their breast, waist size and patient's mass.  I suspect your surgeon is just ensuring medical insurance confirms they will pay for the surgery.  Definitely discuss this before the operation and make sure he is aware of your goals and you both agree.  Consent and agreement between patient and surgeon is a very important starting point.

As a rule of thumb
Waist size 32 - 120 g reduction reduces the breast by a cup
Waist size 36 - 140g reduces breasts by a cup
Waist size 38-40 - 160g reduction reduces breast size by a cup
Waist size 42 - 180-200g reduction reduces breast size by a cup
The use of liposuction can further reduce the breast without tissue excision.  Be sure to ask him if he plans to use any liposuction and make sure you understand what scar shape you can expect.

All the best

Kelly Killeen, MD, FACS · Answer

It is completely normal to be concerned with your outcome.  200 g will reduce your size about a cup size or so.  If this is not enough to meet your goals, bring it up with your surgeon.  Remember that depending on your starting size, there may be a limitation on how much can be removed safely without damaging the blood supply to your nipple.  I suspect it will not be an issue to remove a bit more tissue.

200g from each breast not enough?

Answers (11)

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