Am I a good candidate for breast reduction? How small would I be able to go? And will my insurance cover? (photos)

I am currently a 42F, I am 21 years old and have had 2 children. I am only 5 feet tall, I am currently overweight and am trying to loose it. Its hard to exercise because my back neck and shoulders always hurt afterwards. I first developed breasts at about 10, I was a chunky kid, when I hit puberty they sky rocketed to C cups. That is when I started getting back pain, I tried physical therapy, it never helped. I am on Title 19 insurance.

Doctor Answers 6

Am I a Good Candidate for Breast Reduction Surgery?

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Thank you for your question and pictures. #Breast reduction can accomplish several things in one procedure. The surgeon can reduce the size of the breasts, make them #symmetrical (same size and shape) and complete a lift. By including a lift with the procedure, your surgeon can also assure correct nipple placement and appropriate areolar size. When you #reduce the size of the breast tissue, you can eliminate some of the medical complications frequently experienced by women with large breasts, reduce sleeping difficulties, increase your likelihood of finding clothing that fits and improve self image. Ultimately the size you choose to reduce your breast to, is up to you and your surgeon. However, if you are removing enough breast tissue to decrease your cup size several sizes, you should notice a significant difference. 
Insurance companies have a number of requirements and an examination will be able to determine if you are a candidate for reduction. Pre-authorization by an #insurance company is required prior to surgery, and the process takes approximately one month.
It may be best to see a plastic surgeon who can contact your insurance company for authorization following a #breast examination to document of your symptoms.  Also, you should also consider seeing your primary physician for an examination and documentation as well. 

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Am I a good candidate for a breast reduction? How small would I bea ble to go? And will my insurance cover?

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Hello! Thank you for your question. It is a safe procedure, in which your plastic surgeon will reduce the amount of breast tissue, reshape your breasts, raise the nipple-areolar complex to its appropriate position (possibly making the size smaller, if needed), and ultimately ameliorate the possible complaints that you do have for the reason that you are having this procedure (e.g., neck/back pain, migraines, rashes/infections, shoulder grooving, etc).

It would be in your best interest to lose weight prior to surgery to minimize the risk to you as well as have a mammogram prior to the procedure for screening prior to this procedure, as the architecture imaging of your breast will slightly change afterwards. Well known data exists that having a breast reduction will in fact lower your chance for developing breast cancer, simply because the amount of tissue will be less.

Consult with a board-certified plastic surgeon who will discuss the procedure with you, examine, and assist you in determining if this is the right procedure for you. Voice your complaints - your insurance will likely require a detailed description of your history and complaints as well as photo and an estimate of how much tissue will be removed. You should give a description of the therapies that you have done to ameliorate your complaints thus far. Any other notes from other physicians is helpful. It would also behoove you to discuss your issues yourself with your insurance carrier. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Breast Reduction

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Hi Rebecca,
I am sorry you are suffering, that is a real bummer.  Yes, if you have a skeletal imbalance affecting your posture and contributing to back discomfort, insurance will usually pay........but depending on the amount removed versus your weight and height.  Call your carrier first, and check it out. Be sure to see only a board certified plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons). All the best, "Dr. Joe"

How small would I be able to go

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Actually your first efforts should be weight control, as you will be batter candidate and have a far better result after breast reduction if you are closer to an ideal body weight. You will also find your insurance likely to decline coverage if your weight is too high.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Insurance Coverage

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Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX

Am I a good candidate for breast reduction? How small would I be able to go? And will my insurance cover?

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Thank you for the question and picture. At some point, you may be an excellent candidate for breast reduction surgery. It will be best for you to achieve a long-term stable weight prior to undergoing this procedure however.  Generally speaking, the “ideal” patient for breast reduction surgery is one who presents with relatively large breasts in proportion to the remainder of her torso.  These patients often present with neck, back, shoulder discomfort, bra strap grooving, postural changes, and occasionally with rashes/infections. This operation tends to be one of the most patient pleasing operations we perform.

Once you have reached a long-term stable weight and are still considering breast reduction surgery your next step will be in-person consultation with well experienced board certified plastic surgeons.  Ask to see lots of examples of their work and make sure you feel comfortable with the quality and consistency of the work performed. During these consultations, you may be able to see other patients ( similar to yourself) who have undergone breast reduction surgery.

Ultimately,  you will need to decide whether the “pros” ( benefits) of breast reduction surgery outweigh the potential “cons” ( potential risk/complications).  You may find the attached link helpful to you as you educate yourself about the pros/cons of the breast reduction procedure.

Then, it will be important that you communicate your goals clearly with your plastic surgeon and make sure that you have realistic expectations prior to proceeding with any type of surgery. In regards to breast size desired, also communicate carefully. In my practice the use of goal pictures are helpful in this regard; a discussion of cup size can be confusing and imprecise.   Therefore, I would not suggest that you communicate your goals and/or base your satisfaction with the outcome of surgery on achieving a specific cup size.
 I also find that the use of pictures is more helpful than the words “natural” or "proportionate” etc., which can mean different things to different people. Many of my patients choose to have enough breast tissue removed to help alleviate symptoms while retaining enough breast tissue to remain proportionate to the remainder of  bare torso. Again, preoperative communication will be critical.

Sometimes breast  reduction surgery is covered through health insurance. The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. 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.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Best wishes.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.