Why does it matter for insurance if I have a large reduction w/o keeping nipples?

Question

I’m currently a 42J wanting to go to a C cup. I’m almost 50, long done with breastfeeding and don’t have a sexual interest in nipples. In research on a reduction from my size it’s clear I’d need FNG which seems like it’s unnecessary extra stitches, risks and healing. I’d like to just have the reduction without re-attachment of the nipples. I read that insurance might not cover it that way - but if I’m having plenty of tissue removed based on the medical necessity criteria why would it matter?

Ronald J. Edelson, MD · Answer

The insurance company is interested in one thing. The weight removed. What is done with your nipples won't matter. Unless the surgeon is going to try to bill insurance separately for the FNG which they will deny and is not ethical to charge.

Daniel Barrett, MD · Answer

Dear bullarw,
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

Gary M. Horndeski, MD · Answer

As others have stated, the insurance companies are only interested in the weight being reduced. However, the technique I recommend 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. This technique is not covered by insurance.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Jose A. Munoz, MD - Account Suspended · Answer

Hi and welcome to our forum!I have not come across this question before! The procedure of breast reduction often alleviates neck pain, shoulder pain, back pain, bra strap grooving, and chronic rashes beneath the breasts due to breast weight. The medical necessity of the procedure will not change whether or not there is nipple areolar amputation. The procedure is simpler and shorter. This may actually even save the insurance company money! From the insurance standpoint, different companies have different criteria. Some will require a surgical specimen to be of a certain weight, most will accept symptoms, some require a course of preoperative physical therapy.I recommend a consultation with a board-certified plastic surgeon. After evaluation / examination, a letter requesting preauthorization can be submitted to your insurance carrier.It may be wise to contact your insurance carrier and request their criteria for breast reduction.Best wishes...

Why does it matter for insurance if I have a large reduction w/o keeping nipples?

Answers (4)

More Breast Reduction Questions

Is it normal for there to be clear, cloudy, white liquid from nipples 9 months post-op? I am not pregnant or breastfeeding.

16 years post-op reduction with free nipple graft and my areolas get extremely dry and flaky. Any clues what this could be?

Can the sometimes poor shape from the Bellesoma breast reduction/lift technique be improved by more reduction?

Why is my right nipple dry, peeling, and has fluid 8 months after Breast Reduction? (photos)

What Breast Reduction method is best and how much should I remove? (photo)

Will my nipple placement change after breast reduction? (photo)

WE SEND PRETTY
EMAILS