Will I Be Able to Meet Insurance Requirements for Breast Reduction?

I am a full 36D cup. I am 5 10 165 lbs. Insurance is requiring at least 527 grams per breast, is that too much? How will it look?

Doctor Answers 6

Breast reduction

Breast Reduction is a complicated procedure that is best done by those with the most training and experience. It is very difficult to determine the resultant cup size and shape based solely on the number of grams that are removed from your breast to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast reduction and lift surgeries, including different approaches, techniques and even fat transfer and implant choices if you are lacking superior breast fullness.
This is because several measurements—not to mention breast characteristics such as density—are needed to determine how much and where to remove breast tissue to meet your goals. Without knowing your existing breast shape, dimensions, and the density of your breast tissue, it would be difficult to make this determination. For example, the same volume of breast tissue will weigh different amounts (measured in ounces or grams) in different people depending on its density. The existing base width of your breast and what you will ultimately want to look like will determine, in many cases, the maximal volume and weight that will need to be removed for the best result.

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Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Breast Reduction and Insurance Coverage?

Thank you for the question.

Congratulations on your decision to proceed with breast reduction surgery; it is one of the most patient pleasing procedures we perform.

Unfortunately, without direct examination is not possible to give you accurate advice;  I would suggest consultation with well experienced board-certified plastic surgeons.  After your examination, your surgeons will be able to give you a prediction of what the 527 g per breasts may leave you with.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Insurance coverage and breast reduction

Without seeing your photos or performing an exam, it is difficult to say what you might need to be done. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Insurance coverage and weight of breast tissue required for breast reduction

IF you are only a D and seeking over a 500 gm reduction, it is possible that you are likely to end up with a small B or A cup. IF you are willing to undergo this dramatic of a change, you may be pleased with the outcome. The risks of compromising the neurovascular supply to the nipple increases with increasing reductions.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Meeting Insurance company's Breast Reduction Requirements

If you KNOW that your insurance company will pay for the operation (if you have 527 gm removed per side) you are already way ahead of most women who do not know IF their company would even pay for the operation or what each company's requirements for coverage may be. The only question before you is ; do your shoulder and neck discomfort justify the loss of at least 527 grams per side?

While no one can accurately tell you what that means since cup sizes are AT BEST an estimate and far from being an accurate measurement of breast volume. Moreover, as most women know, the cup size of one manufacturer does NOT always match that of another. In other words a C is not always a C. Talking in cup sizes is notoriously inaccurate and is the reason most of us prefer not to guess.

Roughly speaking, 250cc = 1 cup size, so 500 cc may be equivalent to 2 cup sizes. In your case, removal of over 500 grams may end up with either C cup or full B cups - again - not a very accurate estimate.

You need to decide if the exchange is worth it.

Good Luck.

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Insurance coverage for breast reduction.

Insurance Coverage for Breast Reduction

Answer by George J. Beraka, MD
Manhattan Plastic Surgeon
80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2) Very big reductions (like from an F cup to a C cup) will usually be covered.

3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7) Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9) Don't give up. If the first request is denied, demand an appeal.

10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 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.