Am I a candidate for a breast reduction surgery, based on my description?

Question

How does BSA determine the need for a breast reduction surgery for insurance qualification? do I qualify for a Breast Reduction surgery that may be covered my Aetna Insurance? How is BSA a factor in Breast Reduction Surgery and based on my BSA, am I a candidate for Breast Reduction surgery covered by Insurance?

Gary M. Horndeski, MD · Answer

Your BSA is 2.12 m2.  That is used by Aetna with a table that determines the weight that needs to be removed.  However, 5’6 and 220 lbs, your BMI is 35, which puts you at a high risk for complications.  As stated by others, insurance companies often find reasons to reject reductions.  If you do want a reduction another alternative to consider, even with a high BMI, is liposuction of your breasts.  This can be done to take the weight off your breasts but then your skin may hang.  It is in your best interest to lose weight for optimal results from an incisional breast reduction.  The technique I recommend for a breast reduction is The Bellesoma Method.  This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.  Best Wishes,Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

I’ll be honest with you I don’t know what BSA is. What I do know is that getting certification is often difficult and insurance companies try to deny them whenever they can. In your case they are likely to tell you to lose weight. You should call the insurance company and ask how to go about authorization. Just expect it to be a hassle.

Daniel Barrett, MD · Answer

Dear B4376,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.

Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Scott C. Lindsay, DO · Answer

Hello and thank you for your question. Your BMI is currently too high. You should lose between 20 and 25 lbs before having the surgery. Reason for this is safety and healing issues. Consult with a board certified plastic surgeon to discuss your options. Best of luck!

Jeffrey C. Hamm, MD - Account Suspended · Answer

The BSA  measures body total surface area used to calculate certain drug dosages and insurance requirements. Each company has different criteria..
BMI is a measure used to determine the degree of obesity. Body mass index equals weight in kg /
square of height in meters). You can find BMI calculators on the internet. If
your BMI is > 30, the cosmetic result will not be optimal. If your BMI is
> 35, your operative risk will rise. Your BMI is 35.51.Because of your weight, your operative risk will be increased, and it is suggested that you lose 25 pounds prior to your surgery. Weight loss through diet and exercise
is recommended. If not achievable, a bariatric procedure (such as a gastric
sleeve) will result in significant weight loss. 
Visit a board certified plastic surgeon for in-person evaluation and discussion.
Best wishes...

Am I a candidate for a breast reduction surgery, based on my description?

Answers (5)

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