Do I qualify for a breast reduction?

Im 21 years old, 5ft & 145 lbs my bra size is 38F my upper back is killing me, I can't stand for long , I cant sleep at night cause of the pain, I went through physical therapy and all Pain meds dont even help nomore my friends told me I should look into a breast reduction but will I qualify ? I have McClaren health plan

Doctor Answers 3

Breast Reduction Candidacy

Thank you very much for your question and detailed physical description. From your information, it sounds like a breast reduction could provide relief from your heavy, pendulous breasts. However, you will need to speak with your insurance company to determine if a breast reduction is covered under your plan. I recommend that you schedule a consultation appointment with an experienced, board certified plastic surgeon for an in-person examination. His/her office can assist in determining the medical necessity of a breast reduction, as well as provide help understanding your medical benefits.  

Houston Plastic Surgeon
4.8 out of 5 stars 99 reviews

Breast reduction

You are best to check with your insurance company to determine what the criteria are for approval of a breast reduction. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Breast reduction candidate

Based on your description, it sounds like you are an excellent candidate for breast reduction!  Given that you have very large breasts causing back issues, and have failed a course of PT and pain meds, it seems obvious to me that this surgery could help tremendously.  As far as insurance coverage, you probably meet criteria for coverage, but you would need to see a board certified plastic surgeon to get a note saying you are an appropriate patient for the procedure, and you or your plastic surgeon would then need to run things by your insurance carrier.  Your insurance may also require you to get a note from your physical therapist and primary care doctor saying you need the surgery as well.  Even if your insurance provider will not cover the surgery, you should look into having it done on your own as it could dramatically improve your back issues.

Robert Cohen, MD
Santa Monica Plastic Surgeon
5.0 out of 5 stars 39 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.