I'm a 34G and Waiting on Insurance Approval for my BR. Want a D but PS Said Based on Insurance Regulations? (photo)

Hello, I'm a 34G and waiting on insurance approval for my BR. I would like to be a D but PS said based on insurance regulations I might be a C. I want a round look on top also, based on my pics will I need implants or will a BR and lift suffice? (photo)

Doctor Answers 5

I'm a 34G and Waiting on Insurance Approval for my BR. Want a D but PS Said Based on Insurance Regulations?

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Thanks for the photos. Based upon the requirements of YOUR health insurance plan I believe a minimum of 500 grams of tissue needs to be removed per side. So it is possible that you will be a small D cup or even large C cup. If you have implants at the same operation you will have pay for this portion of the operation and have the risk your insurance will deny coverage. It is a very slippery slope. I recommend having the reduction only, heal over 3 months than see what you appear like- hopefully a D cup. 

Breast reduction and implants

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First, I agree with Dr. blinks as to the resection and cup size. If you have implants in the same procedure, the insurance company will, in all likelihood, deny the entire case as cosmetic, leaving you holding the bag for the entire cost at the full rate. I think you have to be honest with yourself as to your motivation for having surgery. If it is really to have a lift and to retain breast volume, then you could have a small reduction/lift which would not be covered by insurance. However, if your goal is to have surgery courtesy of the insurance company to alleviate back pain, then the price for this is complying with its gram weight requirement. In your case, a C cup is certainly not an unreasonably small size.

Breast reduction

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The additional information of your height and weight would be helpful but you appear to have enough breast tissue to give you and your insurance company what you and they want. Go for it.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 37 reviews

Breast Reduction - Insurance Regulations?

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In general, for someone who is a G cup the normal 500 gram (per side) reduction that is required by an insurance company will take you down about 2-3 cup sizes.  Each person is different, of course.  Since a G is supposed to be equivalent to a 4D, that should reduce you to a D.  However, the decision is made by weight, not volume, so if your tissue is less dense it may take more to achieve 500 grams.

This is clearly something you'll have to go over with your PS and make sure you're on the same page.  You either have to have enough off to qualify for insurance coverage or, if the surgeon does not take off enough to meet those requirements, you have to be prepared to pay for the surgery on your own.

So you need to touch base with your PS.

I hope that this helps and good luck,

Dr. E

Breast Reduction ad Insurance Coverage?

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Thank you for the question.

The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. 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.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you're saying a well-trained/experienced board-certified plastic surgeon.

Prepare to be persistent.

I recommend that you have the breast lift/reduction first and after you have recovered and can see the final results, decide if you would like to be larger and have breast implants placed.

Best wishes.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.