I am a full 38D cup & will be having a breast reduction soon

Question

I had a breast lift done 2yrs ago & it did not relieve my symptoms of back ,neck & shoulder pain . ( I've had large breasts since I was 12 yrs old ) So I've recently been approved for breast reduction surgery by my insurance . However , I am told that 1 pound of breast tissue from each breast would need to be removed . I am concerned . Would this make me too small ? I'm fine with a full b cup but anything smaller would be too small in my opinion

Ellen A. Janetzke, MD · Answer

Having to remove about 1 pound of tissue from each breast is fairy common. It used to be required to remove 500g (just over 1 lb) from each breast on everyone. Most insurance companies have adopted the use of the "Schnur scale" that determines how much needs to be removed based on your body surface area (which is calculated from your height and weight). It is hard to know exactly what size you will end up after the tissue removal (especially without examining you). It depends how dense your breast tissue is as well. If it is made up of mostly fat cells, the tissue that is removed will not weigh as much as it would if it was dense breast tissue. I would discuss these concerns with your surgeon as he or she should be able to give you at least a rough idea.

Payman Danielpour, MD, FACS · Answer

It is very difficult to comment and answer your question properly without seeing you in person or at least seeing pictures.  Most insurance companies require at least 500 grams to be removed so I would ask your insurance company and perhaps have a bit less than 1000 g removed and therefore get the result you are looking for.

Richard H. Tholen, MD, FACS · Answer

The amount of breast tissue that must be removed to fulfill insurance requirements is based on not only a whole list of subjective symptoms (that every woman with large breasts pretty much have), but also on objective factors, including height and weight (BMI). You do not give a height or weight, so your first step would be to go to an ABPS-certified plastic surgeon (preferably one who offers no-charge consultations, as I do in my office) and have an examination and the formula computed for your height and weight.Unfortunately, even if you are short and petite, and the formula comes up with a certain number of grams per breast that is the minimum to be removed in order for you to qualify form insurance coverage, most insurance carriers have a 400g (per breast) minimum that must be removed. That is nearly one pound per breast.For example, if you are 5' 3" tall and weigh 115 lbs., the formula specifies that a minimum of 270 grams per breast would need to be removed. This means that the insurance company-mandated "minimum" of 400g per breast removal would kick in. If you are taller or weigh more, then you may have to have even more than 400g per breast removed in order to qualify for insurance reimbursement. This is something you do NOT want to find out AFTER you have had the surgery and get the entire bill because your surgeon did not take off "enough."Especially because you had prior breast lift surgery, you may indeed end up being "too small" if your surgeon removes the amount mandated by the insurance company's requirements. See one or more ABPS-certified plastic surgeons who can figure out what needs to be removed based on your insurance company's requirements, and then ask to see a breast implant of that volume and try to imagine taking that amount in your hand from each breast, and what will remain. There is your answer to "Too small or not?" I suspect you may be correct in your concern, but would need your height, weight, and present breast size (as well as desired "after" size) to give you meaningful advice. Since bras all differ so much, and patients choose how they "fill" their bras differently, a "full 38D cup" really is meaningless in helping with this determination. Best wishes! Dr. Tholen

Mahsa Moghaddam Smoot, MD · Answer

Thank you for your question and congratulations on qualifying for a medically necessary breast reduction. It is common for insurance companies to require a certain amount of 
breast tissue be removed from each breast in order for the breast 
reduction to be considered a medically necessary procedure covered by 
insurance. The proposed amount or weight of breast tissue to be removed 
is determined based on your height and weight. Often this weight 
requirement is in conflict with a woman’s aesthetic goals. Insurance 
companies are less concerned with the way you look. Yet physical 
appearance after breast reduction surgery can have an impact on quality 
of life regardless of the weight of breast tissue removed. Breast 
reduction surgery is often performed as an elective procedure 
without insurance coverage. Patients choosing elective cosmetic breast 
reduction have control of the volume of breast tissue removed.It's not possible to estimate your result without  a consultation and a physical exam. Bra sizes are an unreliable way of measuring breast size as cup size varies with each bra manufacturer. I encourage you to seek a consultation with more than one experienced plastic surgeon to discuss your goals and to determine whether you would be satisfied with having one pound of tissue removed from each breast. Breast reduction should be considered within the context of each 
individual woman’s quality of life. If you disagree with your insurance 
carrier’s decision, you are entitled to multiple levels of appeal of 
which you should take advantage. I wish you the best!

Richard Chaffoo, MD, FACS, FICS · Answer

Hi and thanks for your question. It's imposdible to give you medical advice without a personal consultation. You should ask your plastic surgeon these questions. It is not unusual to remove a pound of tissue from each breat but that decision is made by your surgeon. Best of luck!

Tom J. Pousti, MD · Answer

Congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. Keys to success: select your plastic surgeon carefully. Then, after careful physical examination and careful communication of your goals, he/she will be able to help you determine whether removal of "1 pound of breast tissue" will leave you too small, or not. 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 “full B cup”  means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. 
Best wishes

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

Thank you for the question but a fullexamination or photos would be helpful to answer your question so see some experts in your areaDr Corbin

I am a full 38D cup & will be having a breast reduction soon

Answers (7)

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