Hi — thank you for the thoughtful question. You’re dealing with real symptoms (rashes, discomfort, skin issues) and a valid concern about scars and surgery cost. Let’s break this down in a way that helps you decide with confidence.1)Insurance Coverage for Breast Reduction — Yes, It Can Be CoveredBreast reduction is often covered by insurance when there are functional and medical issues, not just cosmetic desires.Common criteria insurers look for:-Documented chronic rash under the breasts- Persistent intertrigo or skin infections despite proper care- Pain in back, shoulders, neck- Nerve irritation or bra strap grooving- Interference with daily activities or exercise- Documented large breast size that is disproportionate to frame- Conservative treatment attempts that failed (creams, barrier dressings, PT, weight management)With your history — 36–38 J → flat 32–34 I after weight loss and persistent rash — this fits medical necessity criteria for many insurers.Insurance doesn’t approve surgery because your bra size looks big — it approves it because function is impaired.What to do for coverage:- See a surgeon comfortable with insurance submissions- They’ll document:Skin findingsRash charting/photosChronology of failed treatmentsImpact on activities and quality of lifeYour BMI and body proportions- Then submit a pre-authorization to Blue Cross/your plan- Sometimes imaging is requested (not always)A good surgeon who understands insurance will guide you through this — you do not need to navigate it alone.2) What About Bellasoma / Internal Bra?Let’s be clear:The internal bra (Bellasoma or similar ADM/mesh) is not a treatment for weight or rashesIt doesn’t reduce weight or tissueIt adds foreign material that can stiffen the breast or increase risk of inflammationIt is often pitched as a “support” idea when the real issue is breast weight + skin foldsIn your case, where the weight itself causes rashes and discomfort, an internal bra won’t fix the root cause.Compared with a Push-Up Breast Reduction, internal bra alone is not a meaningful solution.So if your goal is to relieve symptoms, internal bras are not the right answer here.3) Scar Concerns — Especially in Skin of ColorYour concern about anchor scars is absolutely valid — and I hear you. In skin of color, scars can:Be more noticeableBecome hypertrophic or keloidalTake longer to matureBut there’s an important nuance:The type and direction of tension on a scar matters more than its length.A Push-Up Breast Reduction:Reduces tension across scarsUses internal reshaping so the skin does not have to hold everything upResults in smoother, flatter scars over timeOften heals better than short but highly-tensioned scarsTrying to avoid an anchor scar by choosing a smaller incision (crescent, periareolar) often leads to:Poor shapeEarly saggingNeed for revisionWorse scarring due to tensionSo the scar pattern choice should be about tension and support, not just length.4) About “Flat Is” vs “J Again”You mentioned you don’t want to go back to flat I’s, but you also don’t want heavy breasts.Here’s how that’s approached:Option A — Breast Reduction / Push-Up Lift- Removes excess weight- Improves shape and projection- Reduces rashes and pain- Results in a proportionate, lifted C or D- Still looks and feels feminine- Better for posture and activityThis is usually the best balance between symptomatic relief and aesthetic comfort.Option B — Breast Augmentation Again- Increases volume- Doesn’t fix weight issues- Can worsen rashes and mechanical discomfort- Doesn’t address your original symptomsSo while you could go up again, this does not address the problems you’re experiencing.5) Realistic ExpectationsWith a Push-Up Breast Reduction:You can expect significant relief from rash and discomfortYou can achieve a proportionate breast that fits your frameScars usually mature well over the first 12–18 monthsInsurance often covers this when documentation supports itYour result would be lighter, more athletic, and far more comfortable — not floppy or flat — if done with modern tissue-preserving techniques.
