43 yo, and have been wanting a reduction since i was a teenager. Are my breasts big enough for insurance to cover?

Hi, thank you for sharing your question. Based on your symptoms, you may be a candidate for breast reduction and it’s likely that your insurance will cover it. The exact amount of removal and size of the resultant breasts are better determined after an in-person evaluation.

The likelihood of insurance covering your breast reduction surgery largely depends on the symptoms you experience due to symptomatic macromastia. Symptomatic macromastia is characterized by heavy breasts that can lead to various physical and emotional symptoms.
Chronic Pain: Persistent pain in the neck, back, and shoulders due to the weight of the breasts. This pain can interfere with daily activities and significantly impact your quality of life.
Skin Issues: Skin irritation and infections, particularly under the breast crease, due to moisture and friction.
Grooving: Deep grooves on the shoulders from bra straps supporting the heavy breasts.
Posture Problems: Poor posture and related complications due to the forward pull of the heavy breasts.
Limited Physical Activity: Difficulty engaging in physical activities or exercise, leading to a sedentary lifestyle and related health issues.
Nerve Pain: Tingling or numbness in the arms or fingers due to nerve compression.
Emotional Distress: Emotional and psychological distress, including low self-esteem and social anxiety, stemming from the appearance and discomfort of large breasts.
Given your symptoms of feeling heavy and sore 24/7, combined with the fact that you've wanted a reduction since your teenage years, it is evident that your condition significantly impacts your life. You should schedule a consultation with a plastic surgeon to discuss your options.

I would recommend breast lift with a slight reduction. You appear to have a C cup breasts and would be better served with a lift than with too much reduction. Insurance will not cover this amount of reduction usually.

Insurance will not cover your breast reduction as your breasts are not an adequate size. You would benefit from a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.

Best Wishes,

Gary Horndeski, M.D.

Hello,

And thank you for the question.

Based on your photos and the fact that your large/heavy breasts are causing you physical symptoms, breast reduction covered through insurance may be an option for you. However, it is difficult to tell without in person consultation.

During breast reduction surgery, excess breast tissue is removed, the breast is lifted and nipple/areola is typically made smaller. It is easiest to think of breast reduction as including the breast lift.

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.

Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon

Thank you for your question.
It depends on your health insurance company. Give them a call and find out what the criteria is to have a breast reduction. Best of luck!

No, your breast reduction will not be covered by insurance since to qualify, about all your breasts would need to be removed. Most companies want at least 500 grams, or over one pound per side, which is about 2 to 3 cups of tissue. However, you still can have a reduction if you choose to pay.

And today’s medical insurance industry breast reductions approval are limited due to over use in the past. Based on your post of photos, you are borderline being approved for breast reduction. Plus, the reimbursement from the insurance companies has been going down in recent years that it’s not cost-effective to only do the breast reduction for insurance payments. Best to do in person consultations to see exactly what insurance plan you have if the restrictions to breast reduction surgeries or what the possible reimbursements are. Out-of-pocket fees to range from $1000-$5000 depending on each insurance plan. Best of virtual consult with

Each insurance policy will have specific criteria that must be met for coverage. Some potential criteria include removing a minimum number of grams per side and documented alternative attempts at symptom control (ie. physical therapy, medication, etc). Some have no coverage for any reason. From the photo it does appear you would be a good candidate for a lift with reduction even if your insurance does not cover it.