Insurance says 628 grams must be removed for breast reduction surgeon says 550-600 grams. How much difference would there be?

Question

I asked for c cup after surgery and was told taking 628 grams would make it an A cup. Why so much difference and what would be the argument for medical necessity to take only 550-600 grams?

Gary M. Horndeski, MD · Answer

If you desire a C cup and the surgeon predicts an A cup then you will be dissatisfied with the results.  You are operating to satisfy the insurance companies requirements but not your own.  I recommend you have surgery that will satisfy your requirements and have breasts proportionate to your body size.  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.

Ronald J. Edelson, MD · Answer

This is a tough predicament. Some surgeons are better at estimating tissue removal than others. You or your surgeon should address this to the insurance company and tell them it’s close but you don’t want to be over reduced. Try asking a different insurance employee until you get the answer you need.

Robert L. Kraft, MD, FACS · Answer

The gram weight requirements are based on the rationale for covering breast reduction, functional medical necessity. If fewer grams are removed, per the insurance guidelines, it would be a lift, not a reduction, and not entitled to coverage.   if you want to remove less, the case would be fee for service. Ask to see photos as cup sizing is inexact and Subject to multiple interpretations.

Insurance says 628 grams must be removed for breast reduction surgeon says 550-600 grams. How much difference would there be?

Answers (3)

More Breast Reduction Questions

I am 190 lbs with 38HH breasts. I want reduction and a lift. What is the lowest cup size I can safely expect? (photo)

I have a VP shunt. Can I still get breast reduction?

Breast reduction, breast lift or small implants? (Photo)

Breast reduction size decision. Should I go with a B or C cup for a proportional look? (Photo)

Breast Reduction from DDD to C cup?

How much weight do I actually need to lose to get a breast reduction?

WE SEND PRETTY
EMAILS