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

Question

I am 43 yo, and have been wanting a reduction since i was a teenager. They are very dense. They feel heavy and sore 24/7

Finny George, MD · Answer

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.

Elizabeth Kiwanuka, MD, PhD · Answer

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.

John Michael Thomassen, MD · Answer

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.

Gary M. Horndeski, MD · Answer

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.

Camille Cash, MD · Answer

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.

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

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Answer: Bellesoma Method

Answer: Bellesoma Method

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

Answers (9)

Answer: Bellesoma Method

Answer: Bellesoma Method

Answer: Breast reduction

Answer: Breast reduction

Browse related questions

Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.