Based on your single photo, there are several issues to discuss here.First, bra manufacturers have notoriously different sizing "standards," so one 32DDD bra may contain more (or less) volume than another manufacturer's bra. This is not the way to determine amount of tissue removal.Secondly, as a reviewer for Blue Cross/Blue Shield and Medicare for many years, I can tell you that virtually all (except maybe a few high-cost private insurance companies) insurance providers use the Schnur formula which uses height and weight to calculate BMI, then applies a graduated scale as to the exact amount of tissue to be removed per breast in order for insurance coverage. 1 gram too little and you get the entire bill, and it will be in the 5 digits, I promise. Virtually all of these same providers have a "minimum" anount of tissue to be removed in order for coverage to be obtained, and that "minimum" is almost always 400g per breast, not 200g per breast. Perhaps you misunderstood, but 400g PER BREAST would need to be used since your calculation takes you below the minimum (for your height and weight). Not 200g per breast. A can of soda is 360cc (12 oz at 30cc per oz), and removal of this volume of tissue from each breast, plus an ounce and a half more to get to 400+ per side, would indeed leave you a bit smaller than you are thinking. Read between the doctor's nurse's lines--you are young, slim, and with large breasts. Since your photo doesn't show, I can't tell how much sag or droop you have, or if your nipples point "south" or forward and perky, or if you have other symptoms that insurance coverage requires. But realize that the "formula" is unforgiving and that if your surgeon removes 1 gram too little, YOU get the bill. You won't get far in trying to get your surgeon to pay since he "told you" that 200g per side would do it; that would be your misunderstanding and your loss in court. (And then you still pay the bill). If YOU ended up paying the bill for this (and I'm pretty certain that you will if your surgeon only takes 200g per side), would you think it's OK for the lighter load (in your purse--$10-12K or more, depending on where the surgery is done), and all the scars on your breasts, not to mention the 15% or so loss of sensation or ability to breast feed?Trust me, this is a great operation for the right candidate, and I think the doctor's nurse was advising that you should just say "NO." The nurse's advice is often more accurate, since she gets paid the same if you do or do not schedule surgery. Unfortunately, not every surgeon will be as selfless as to give the most accurate advice when s/he gets a "big case" to schedule. If you said, "It's still worth it and I'm willing to pay myself for 200g per side to be removed," well, then OK. But, you won't be an A-cup; you will only be down about a cup size with 200g per side, and perhaps that's fine with you. But then it's called a cosmetic reduction and is NOT covered by any insurance plan. So see one or more ABPS-certified plastic surgeons who do lots of breast surgery and get more (accurate) information. You can also ask to see and feel 400cc (same as 400g) implants and more accurately imagine just how much that would take from each side, and then decide if that's too much. I suspect it will be. Best wishes! Dr. Tholen
