I get migraines, neck pain and back pain. Will I be approved by insurance?

Question

I am a 37 year old Mother of 4. I have had extremely large breast since I was 13. I was a full C cup back then. I was a triple D in high, and for 6 years now I have from a G to 38 K cup. I have 2 referrals from my primary and OBGYN. I get horrible migraines, stick neck, and horrible back pain that takes my breath away at times. I have the grooves and the permanent skin wearing and rashes. I have BCBS but I'm scared they won't approve it. I will go for consult tomorrow? Any advice?

Camille Cash, MD · Answer

From everything you have stated you sound like a great candidate for breast reduction.  Each carrier and each policy will have its own set of criteria that must be met in order to obtain approval.  I encourage you to speak with your surgeon about everything you stated above as well as any treatments, such as physical therapy or pain medication you have tried in order to find improvement.  Your surgeon will document all of these items when it is submitted to insurance for approval.  Best wishes to you.

Elizabeth Kiwanuka, MD, PhD · Answer

Breast reduction surgery, also known as reduction mammaplasty, is a procedure performed for both medical and aesthetic reasons. The primary indications for this surgery include:
Physical Discomfort: Women with overly large breasts often suffer from back, neck, and shoulder pain. The weight of excess breast tissue can impair the ability to lead an active life and cause physical discomfort.
Skin Irritation: Chronic skin irritation under the breast fold is another common issue. This can lead to skin infections and discomfort.
Postural Problems: Large, heavy breasts can lead to poor posture and even skeletal deformities over time.
Psychological Distress: Some women may experience self-consciousness, body image issues, or psychological distress due to the size of their breasts.
Breathing Difficulties: In extreme cases, heavy breasts can lead to breathing difficulties.
Limitations in Physical Activity: Large breasts can restrict participation in certain physical activities or sports, affecting lifestyle and health.
Poor Fit of Clothing: Difficulty in finding well-fitting clothes can be a practical concern leading to this surgery.
Asymmetry: In cases where there is significant asymmetry between the breasts, reduction surgery might be considered to achieve symmetry.
It's important to note that candidates for breast reduction surgery should be in good general health, non-smokers, and have realistic expectations about the results. A thorough consultation with a qualified plastic surgeon is essential to determine if breast reduction is appropriate for an individual’s specific circumstances.
While a lot of insurance plans do cover breast reduction surgeries, it's important to contact your insurance provider to confirm coverage details.

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.  Insurance does not cover this technique and the cost is $14,000.

Best Wishes,

Gary Horndeski, M.D.

Scott C. Lindsay, DO · Answer

Hello and thank you for your question.
You seem like your are a great candidate for breast reduction surgery. Bring along all documentation from your physicians to your plastic surgeon consultation. Everything will be sent to your insurance company to help get your procedure approved. Best wishes!

Randal Haworth, MD, FACS · Answer

It sounds like you are experiencing significant discomfort and medical issues due to the size of your breasts. Going for a consultation with a qualified plastic surgeon is a crucial step to discuss your concerns and explore the possibility of breast reduction surgery.

During the consultation, make sure to communicate all your symptoms, pain, and difficulties you've been experiencing to the surgeon. They will conduct a physical evaluation and review your medical history to determine if you are a suitable candidate for breast reduction surgery. Having the referrals from your primary care physician and OBGYN can also support your case for medical necessity.

Regarding insurance coverage, each insurance plan may have specific criteria for approving breast reduction surgery. It's essential to check your specific policy and discuss the details with your surgeon's office. They can help navigate the insurance approval process and provide any necessary documentation to support your case.

Breast reduction surgery can be life-changing for individuals experiencing pain and discomfort related to large breasts. It's important to advocate for your health and well-being, and the consultation will give you more clarity on the potential benefits and the process ahead. Best of luck with your consultation, and I hope you find the relief you deserve.

I get migraines, neck pain and back pain. Will I be approved by insurance?

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I get migraines, neck pain and back pain. Will I be approved by insurance?

Answers (8)

Answer: Breast Reduction

Answer: Breast Reduction

Answer: Breast reduction surgery

Answer: Breast reduction surgery

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.