My insurance (Aetna) just approved me for a reduction. The surgeon wants to take 1393g from each breast. Is this rational?

Insurance carriers require that a specific amount of breast tissue be removed in order to deem the procedure medically necessary and not cosmetic.  The weight of 1393 g is very specific and was likely calculated based on the Schnur scale.  That breast tissue amount corresponds with a Schnur scale body surface area of 2.45 m². Based on your stated height and weight, your body surface area is 2.22, which would require that a lesser amount of breast tissue be removed to meet their criteria.   Discuss this with your surgeon. It is also very challenging in my experience to achieve a B or smaller breast cup size with your current BMI of 39 without a nipple graft, because it’s very difficult to leave an adequate amount of breast tissue attached to your nipples for blood flow and innervation and still make you that small.  This needs to be cleared up prior to your surgery. The pre-authorization approval might need to be resubmitted with your new and more accurate BSA.  Of course I have not seen or examined you and have no idea about how large your breasts are or what a reasonable expectation for breast tissue resection weight would be for your reduction. Best wishes to you.

Thank you for your question!
Schedule an appointment with your surgeon to discuss this. You need clarification prior to surgery. Also, 2nd opinions are always a good thing. Best wishes!

Although plastic surgeons hesitate to reference bra cup sizes because of the wide variation between bra manufacturers, very large breasts rarely are reduced by more than two or three cup sizes.  Tissue density will always play a big role in the number of grams removed.  Going too small can sacrifice the shape of the breasts.  The nipple has to have a blood supply to survive from the underlying tissue.Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Such an exact figure is unlikely to be completely accurate but reflects your surgeon’s understanding of insurance criteria. It will not reduce you to a B cup. What’s interesting is that in NY, they would deny anyone with your BMI as obese so the standards appear to be relaxed in other parts of the country.  The operative note must be submitted for payment along with pathology so if you negotiated a considerably smaller reduction, the case could be denied after the fact, leaving you with the bills. 

Hi Keri93, 
The Volume you are asking about is relatively large and with that I would guess your plastic surgeon is planning on doing a free nipple graft technique. That would be the safest way for you to achieve a B cup or a small C cup. This needs to be thoroughly discussed because a free nipple graft would prevent you from future breast feeding. 
It sounds like you and your plastic surgeon should have another consultation and details need to be ironed out regarding and decisions made regarding technique used for your reduction. 
best wishes, 
Tarek V. Copty, MD FACS 
American Board of Surgery American Board of Cosmetic Surgery Jordanian Board of Plastic & Reconstructive Surgery Fellow, American College of SurgeonsFellow, American Academy of Cosmetic Surgery Fellow, International Society of Aesthetic Plastic Surgeons