If I Gain Weight or Get off the Pill, Would I Be More Likely to Be Approved for a Breast Reduction by Insurance?

I am a 36 y/o female /6ft tall/155 lbs /21 bmi. My breasts are large & pendulous & currently a 34 D/DD. I have been on a bc pill that has greatly reduced the weight & fullness of my breasts & my weight is as low as I can comfortably maintain it. My concern is that my breasts will not be large enough for insurance to approve. Would I have a better chance getting off the pill (my breasts are at least 1-2 cups larger) or gaining a few lbs? I hate to have to do either, but the cost is an issue. Thanks!

Doctor Answers 3

Gaining weight to meet insurance requirement? YIKES.

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Okay, think this through:  You gain weight and or alter your birth control to make you breasts larger so insurance will cover your procedure.  You have your surgery and then you decide you are happier and healthier at your lighter weight and on your birth control pills.  Then your breasts end up too SMALL.  What then?  Implants?

I recommend looking into having surgery at your healthy and happy weight and on birth control (if you need to be on it for, well, birth control) and if you don't meet insurance requirements, either save up for or finance the surgery. 


Medical necessity for breast reduction

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Really need a examination to determine if you are a candidate for a breast reduction.  Most insurance companies use some type of combination of your weight, BMI and estimate of amount of breast tissue to be removed to determine medical necessity.  

Gain Weight Before Breast Reduction?

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Insurance companies generaly require a certain weight of breast tissue to be removed in order for the company to pay for the surgery. But that weight requirement usually goes up as the patient's weight goes up. Best to see a surgeon now and see what he thinks. By the way, more than half the reduction patients I see do the surgery as a cosmetic procedure and most of us have fees for cosmetic patients. There are also good financing companies available if your credit is good. Either way, you will love the results and increased comfort after the procedure.

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.