How do surgeons determine how much breast tissue is to be removed in a breast reduction?

In practice, the following elements determine how much tissue is removed during an insurance-covered breast reduction: existing breast size, breast tissue density, patient goal size, and insurance minimum specimen weight. Surgeon skill and judgement is a critical part of this equation as well. Generally speaking, I spend the time to gain a detailed understanding of the breast size/shape my patient wants to achieve with surgery using before and after photos to guide discussion.
The Schnur scale is a method for determining how much tissue should be removed during an insurance breast reduction based on body surface area. It is not a very useful tool for planning surgery except to the extent that it may influence the minimum amount of tissue to be removed to make sure your procedure is covered by your insurance plan.

Hello,
Thank you for the question.
Based on what you are describing, it does sound that you have large/heavy breasts causing physical symptoms, and breast reduction may be an option for you. However, it is difficult to tell without seeing the photos and/or in person consultation.
Schnur Sliding Scale is a scale used by many insurance companies as a guideline for how much breast tissue should be removed in order to improve your physical symptoms. In addition, most insurances in order to approve the surgery, will require for 2-3 letters of medical necessity (from your chiropractor, primary doctor, OBGYN, Dermatologist, etc) demonstrating that your physical symptoms due to large breasts are not improving with conservative management.
The goal of breast reduction surgery it to make the breasts smaller and lifted, but also proportionate with the rest of your body.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon