I have 40M Breasts. At 21 years old, what should I do? Breast reduction, or possibly another problem? (Photo)

Question

2.5 years ago, I was approximately an F/G cup. I now have M cups. Weight ~250lbs have for about a year. Is this growth normal? Am I justified in seeking a reduction and trying to get my insurance to cover it? (BCBS Federal Employee Program) if they grow any larger I won't be able to buy bras. I have a history of back pain and have been to a chiropractor. I am popping pain pills regularly and while I try to exercise (I would like to lose weight) I really only am able to use a treadmill to walk.

Richard H. Tholen, MD, FACS · Answer

You did not say what your weight was 2.5 years ago. As you become more obese, so do your breasts enlarge, though that is not the only cause.Insurance coverage is virtually always related now to objective criteria of height, weight, and amount of breast tissue that will be required to be removed to fulfill the Schnur formula. All of the other symptoms are subjective, and every plastic surgeon knows what to write in the insurance prior-authorization letter. Which is why insurers went to objective (BMI) criteria.  Certainly you may qualify for "coverage," but based on your weight (since your height is "fixed'), you will have to have a significant amount of breast tissue removed in order to fulfill those criteria.Pain, chiropractic care, inability to lose weight, rashes under your breasts, grooves from your bra straps, and numbness from bra strap pressure on the nerves in your shoulders all are listed by plastic surgeons in their letters of prior authorization. But based on your height and weight, a number is calculated, and this is the MINIMUM amount of breast tissue that must be removed per breast in order to qualify for insurance coverage. Regardless of symptoms, exercise inability, etc.To answer your question, I would want you to see your primary physician and run a comprehensive set of tests to evaluate why your overall weight has reached this degree of obesity, not just the breast enlargement part of your anatomy. Even if your breasts are all gland and no fat, losing weight to a BMI of less than 30 will allow safer breast reduction surgery with fewer healing risks. Best wishes! Dr. Tholen

Ted Eisenberg, DO, FACOS, FAACS · Answer

Good question. I always advise my patients to make sure that they have not changed in in breast size, height or weight for two years before they have surgery. That's because if you are still growing your surgical results could change. When you are done growing, your plastic surgeon will need to submit a letter to your insurance company describing your physical symptoms, the amount of tissue to be removed, and a picture of your breasts. The insurance company will then determine if your surgery will be covered as reconstructive or denied as a cosmetic procedure. I believe you would be a good candidate for a breast reduction and get a great deal of relief from the surgery. Best of luck to you.

Keshav Magge, MD · Answer

Thank you for your question, and I am sorry to hear all the suffering you have as a result of your large breasts.  Weight reduction is generally a good idea, but it sounds like your breasts are affecting your ability to exercise and make the weight loss even harder.  Based on your description, you sounds like a candidate for breast reduction especially because of the back pain you have.  Whether insurance covers it is another issue as each company is different and has different criteria.  I would recommend speaking to a board certified plastic surgeon who can examine you and submit to insurance if applicable.  All the best,

Ramiro Morales, Jr., MD · Answer

Thank you for your question and pictures.  I think that you would definitely benefit from a breast reduction and most of the time BCBS will cover the surgery.  Seek a consultation from a Board Certified PS.

Jed H. Horowitz, MD, FACS · Answer

Thank you for your question and photos. Yes! You are a #candidate for a #breast #reduction surgery. Candidates for #BreastReduction surgery
are women who wish to have smaller #breasts to achieve a more proportional
appearance or to alleviate physical discomfort. Breast reduction can correct
symptoms from excessively #largeheavybreasts that may cause the inability to do
certain exercises, or create back, shoulder and neck pain, poor posture,
bra-strap shoulder indentations and chafing or rashes under the breasts. Women
experiencing these discomforts may benefit from Breast Reduction, also called #ReductionMammoplasty.
Furthermore, large breasts may interfere with normal daily activities or
exercise and will be more comfortable when reduced. Women who feel that their
excessive breast size decreases a sense of attractiveness and self-confidence,
or results in unwanted attention are also candidates. In my opinion, it's important to be cleared for a #breastreduction by your primary physician. Best wishes to you!

Steven Wallach, MD · Answer

I think you probably need to lose weight first before considering a breast reduction procedure.  Good luck.

Darryl J. Blinski, MD · Answer

Appears as a candidate fir BREAST REDUCTION surgery. Seek in person opinions.........................

Tom J. Pousti, MD · Answer

Thank you for the question. Based on your description, you may be an excellent candidate for breast reduction surgery. This operation tends to be one of the most patient pleasing operations we perform.   Based on your description also, it sounds like you may benefit from a visit with your primary care physician. He/she may help you determine the causes of weight gain (for example rule out hypothyroidism) to help you with your weight loss program.

“Typical” patients who present for breast reduction surgery are women who have disproportionately large breasts, causing problems such as neck/back/shoulder discomfort, postural changes, bra strap grooving, skin irritation/rashes under the breasts, and/or difficulty with activities of daily living and/or exercise etc. There may be both physical as well as psychosocial “stress” caused by the disproportionately large breasts.

Reducing breast tissue mass and elevating the breasts on the chest wall tend to improve or alleviate many of the symptoms associated with the disproportionately large breasts.Patients considering breast reduction surgery should also consider the potential downsides (risks/complications) associated with the procedure as well. Poor scarring, for example may be associated with the procedure. Additional surgery may be necessary in the short or longer term for a multitude of reasons. Timing of service should be individualized based on the specific patient's  life circumstances and preferences.Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, the more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.When the time is right, I suggest that you seek consultation with well experienced plastic surgeons who can demonstrate significant experience achieving the types of outcomes you would be pleased with.

I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.

Richard J. Wassermann, MD, MPH, FACS · Answer

Hello and thank you for reaching out. Insurance companies have different criteria to determine if they will cover a breast reduction, and unfortunately, it's not the same for every company. With that being said, the doctor's office will file a pre authorization request and submit the required information, and the insurance company will reply with their response. If your BMI is high, that is one indication that might prompt a denial from the insurance company, along with amount of grams estimated to take off, etc. Again, each insurance company has their own set of requirements. If you have any documentation from your chiropractor that states what you have been seen for and the measures that you have taken, that could be helpful in pleading your case. Best Wishes.

Sherwood Baxt, MD (retired) · Answer

Here is a possible alternative. I got to the point with young patients like yourself where I dislike doing traditional reductions. Look into the scarless.....Liposuction only procedure.  It's quick simple does not destroy the physiology and function of the breast and of course the major issue is it avoids the extensive scars which would be inevitable and someone of your size. Just another way of looking at it and hopefully this is of some help.

I have 40M Breasts. At 21 years old, what should I do? Breast reduction, or possibly another problem? (Photo)

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