Is breast reduction the right choice for me?

Question

I’m 19 years old, 137 pounds, 5 feet 3 inches, and wear a 36DD. My breasts cause me back, neck, and shoulder pain. I feel like they’ve affected my posture as well. The NP said most insurance require 950 grams to be removed per breast. I’m concerned that is too much and my breasts will end up too small. I want to be a full C/small D cup. Is a breast reduction the right choice for me?

Gary M. Horndeski, MD · Answer

The technique I recommend is The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Casey Anderson, MD, FACS · Answer

Breast reduction frequently helps with the back and neck pain you have mentioned. Insurance does have requirements as well. Additionally, breast reduction can potentially decrease your chance of breast feeding in the future which may be important to you (or not). 950 seems like a lot - you may need to explore your options outside of insurance coverage.

Irena Karanetz, MD · Answer

Hi,
Thank you for the question. 
Based on your photos, you appear to be a great candidate for breast reductions surgery. During breast reduction surgery, excess breast tissue is removed, the breast is lifted and nipple/areola is typically made smaller. It is easiest to think of breast reduction as including the breast lift. 
Schnur Sliding Scale is a scale used by many insurance companies as a guideline for how much breast tissue should be removed in order to improve your physical symptoms. In addition, most insurances in order to approve the surgery, will require for 2-3 letters of medical necessity (from your chiropractor, primary doctor, OBGYN, Dermatologist, etc) demonstrating that your physical symptoms due to large breasts are not improving with conservative management. 
The goal of breast reduction surgery it to make the breasts smaller and lifted, but also proportionate with the rest of your body. It is reasonable to to expect full C/small D cup breast size after the breast reduction surgery based on your photos.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Scott C. Lindsay, DO · Answer

Thanks for your question! I do think that you would be a good candidate for a breast reduction. We have a lot of patients that require less per breast so I would suggest a consultation with a qualified plastic surgeon. Worst case scenario, if it was important to you, you could pay out of pocket. Most doctors offices have great financing options. Good luck!

Frederick W. Ehret, MD · Answer

Thanks for your question! The most important thing is for you to get an in-person consultation with a board certified plastic surgeon to discuss with you at length the pros and cons of a breast reduction. This is especially important because you're 19 and therefore most of your life is still ahead of you and your breasts will continue to change throughout your lifetime. Once you've had a breast reduction, you will always have had a breast reduction. It will make breast feeding more difficult if not impossible. 
The most common scale that insurance companies use to determine "medical necessity" for a breast reduction is the Schnur scale. Not every insurance company uses this scale however. Using your stated height and weight, your body surface area is approximately 1.65 meters squared. On the Schnur scale, that equates to 338 gram reduction in weight per breast. Always better to evaluate from in-person but from your pictures it looks like you could get a 338 gram reduction per breast and maintain proportion. Smaller breasts, but not small. Seems like you would be a great candidate for an in-person consultation for a breast reduction.

Daniel Barrett, MD · Answer

Dear joooo777,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Michelle Copeland, MD, DMD · Answer

Thank you for sharing! Large breasts may not only interfere with your physical ability to function in daily activities but can be emotionally burdensome as well. Breast reduction is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine, which sounds like your situation. Recently, managed care has adopted stricter standards for coverage, so just make sure these problems are thoroughly documented in writing by your primary care physician and plastic surgeon. They may also have to submit photographs. Even then, you may be required to seek a second opinion from a chiropractor, physical therapist, or orthopedic surgeon.
From what you describe you are a candidate for a breast reduction. Breast reduction surgery removes excess breast tissue and reshapes the contour of the breasts so that they are smaller and perkier. It is possible to do a breast reduction with a minimal scar technique and can also be done as an outpatient procedure under twilight sedation. I commonly use a minimal incision technique (Le Jour), eliminating the need for large scars while providing a pleasing breast contour and shape that is proportionate to the patient’s body. Additionally, breast reduction comes with an added bonus- the removed breast tissue can be sent to the lab and examined by a pathologist for signs of cysts or cancer. It's important to be sure expectations are realistic and you have an understanding of the commitment needed for the healing process. Make sure that you understand the nature of your surgery, the recovery process, and that you feel comfortable and emotionally ready to make these changes to your body. 
I suggest you make an appointment with a board certified plastic surgeon who will examine you and go over your surgical options in detail.

Aydin Gozu, MD · Answer

Hi, I checked your situation. I think breast reduction is needed in your case. Please check our website for information.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and you appear to be an excellent candidate for a reduction though not covered by insurance as you are right that under insurance too much breast would need to be removed

Dr Corbin

James McMahan, MD (retired) · Answer

Thank you for your question and photographs.  You appear to be an excellent candidate for reduction mammaplasty.  Your breasts would be significantly smaller, the nipple/areola complexes lifted and made smaller to match your smaller breasts.  Your NP is absolutely incorrect.  Most require about 450 grams per side in patients who are of normal weight.  Larger amounts for larger patients.  You might as well get the ultimate answer by seeing a plastic surgeon who is board certified and experienced in breast reduction surgery.  He or she can submit to your insurance company and find out definitively whether or not it is covered.

Is breast reduction the right choice for me?

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