I have 32DDD breasts at 135 pounds. Would insurance cover the surgery? (Photo)

Question

I am 23 and I weigh 135lbs. My breasts are about 32DDD (30H, 32G, 32F). Would it be highly likely for insurance to cover a breast reduction surgery? I have had large breasts my whole life, but the past few months I have noticed that my shoulders have started hurting and the pain travels up my back to my neck. I don't know what to do!

Edwin C. Pound, III, MD · Answer

Most insurance companies look at two factors when determining coverage:  1. the amount of breast tissue removed.  They have charts based on height, weight, and body surface area which they use for this, however, based on your pictures, I would think you would qualify on that score.  2.  Functional issues related to your large breasts.  You mentioned a couple of problems you were having.  I think you need to see a board-certified plastic surgeon who can examine you and document all of this as well as review the risks and benefits of the surgery.  Based on your pictures, though, I think you will probably qualify for insurance coverage.

Dallas Buchanan, MD · Answer

Thank you for your question and your pictures.Every insurance company is different in how they allow or cover breast reduction surgery. Most of them usually approve it based on symptoms and a proposed amount of breast tissue that will be removed. As crazy as this sounds, any companies use a formula called the Schnur formula that calculates the amount of tissue needed to be removed by your body surface area (which is calculated based on your height and weight). Assuming that you are between 5 feet and 6 feet tall, with your weight, your body surface area would be roughly 1.6-1.76. If you looks at the link I provided (with a chart for the Schnur formula), that would mean that you would need to have 310-404 grams (0.68-0.89 pounds) of breast tissue removed per breast for it to be covered by insurance.From the looks of your pictures, I think this would be reasonable as long as you have the symptoms that go along with macromastia (large breasts). You need to seek a consultation with a local plastic surgeon. Only through a good physical exam can they tell you whether you would be a candidate for breast reduction surgery and whether your insurance will cover it. They would submit the procedure to your insurance for approval and see what the insurance says. Good luck to you!

Andrew T. Cohen, MD, FACS · Answer

It is very difficult to determine if insurance will cover a breast reduction as different insurance companies have different criteria.  Most insurance companies do cover the surgery if you remove 500 grams of tissue or more from each breast.  You also need to prove and document that you have had symptoms of macromastia.   You do look like you are a good candidate for the surgery.  Having symptoms of neck pain, back pain, shoulder grooves, rashes  are all reconstructive reasons to have a breast reduction.  Your medical doctor needs to see you and document that you have symptoms.   Breast reduction surgeries are the most common that I perform and my favorite operation.  I do 2-3 each week. Always have a Board Certified Plastic Surgeon do your surgery. Good Luck,Andrew Cohen MD

I have 32DDD breasts at 135 pounds. Would insurance cover the surgery? (Photo)

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I have 32DDD breasts at 135 pounds. Would insurance cover the surgery? (Photo)

Answers (3)

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Everything you need to know about Breast Reduction

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