I'm worried about insurance and how much they want to take off. Any suggestions? (photos)

I just had my second consultation on Friday. The new doctor sent in my information for the approval from the insurance on Friday. I'm so nervous. He said that per the Schnur scale they would probably ask to take off 1900 grams per breast at the very least. I am a 46N/O. I am worried that the insurance will deny the reduction or that they'll approve it but the PS won't end up taking enough off. I would ideally like to be a c/d. I'm just wondering if I should be worried.

Doctor Answers 4

I'm worried about insurance and how much they want to take off. Any suggestions? (photos)

Even with a close examination it is not possible to determine how much breast tissue will be removed, but even though 1900 grams seems a lot it is within the range that is usually removed in breasts such as yours.  Communicate your concerns with the plastic surgeon you are comfortable with and make sure you and your PS are on the same wavelength.  Just make sure that your plastic surgeon is well experienced in breast reduction and can show you before and after photos of similar cases.  Hope that helps.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

Breast reduction weight and insurance requirements

Your plastic surgeon will work with you do decide pre-operatively roughly how much breast tissue can be removed from each breast. If this estimate falls below the Schnur table criteria, then you have the option of paying out of pocket for your procedure and getting the type of breast reduction that you really want.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

I'm worried about insurance and how much they want to take off. Any suggestions?

First of all, you are getting ahead of yourself since you have yet to hear from the insurance company. Secondly, no good plastic surgeon is going to take off what the insurance company tells them has to come off, the doctor is going to do what he/she can to help you meet your goal, whatever that weight is and assuming your goal is realistic. The insurance company does not have your interests at heart, it has the interests of their company which means they need to take in more money than they spend and breast reduction is one of the areas where they save money by making unrealistic requirements that have to be met. The worst thing that can happen is you may have to pay for the surgery as about 75% of my breast reduction patients do in order to have the surgery done properly and not to the often unrealistic requirements of the insurance company. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Schnur Sliding Scale for Breast Reduction Surgery

If your doctor determined that 1900 grams of tissue would need to be removed from each breast based on the Schnur Sliding Scale (SSS), then your Body Surface Area (BSA) must be around 2.65.   As you probably know, BSA is calculated using your height and weight.  If you were to lose weight, your BSA would decrease and the amount of breast tissue required to be removed in order to be covered by insurance would be less.   

If your insurance company denies your procedure, and/or if your doctor doesn't think that he/she would be able to safely remove enough tissue based on the SSS, then your motivation to lose weight in order to have your breasts reduced (and lifted) becomes more significant.  

My advice to you would be to see a physician who deals with weight loss first.   I am concerned that trying to take 1900 grams of tissue from each breast will cause loss of blood flow to your nipples, leading to potential loss of your nipples and other would healing problems.

Best Wishes!

Cecilia Franco-Webb, MD
Denver Plastic Surgeon
4.6 out of 5 stars 20 reviews

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.