Do you think I could have 600-700 grams removed from my breasts? (Photos)

Dear Dogmom2014,it is hard to tell for sure without an examination. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. 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

Qualification for breast reduction is a function of the medical necessity and the anticipated resection weight. Patients must demonstrate a medical need typically consisting of symptomatic macromastia (large breasts)- neck, shoulder, back pain, bra strap grooving and intertriginous rashes (rashes in the fold). They must also have shown more conservative measures to be ineffective such as weight loss, physical therapy and pharmacologic therapy.Finally, there are resection requirements. These will vary from insurance provider to insurance provider. Physician estimates are typically based on the Schnur scale which predicts based on body surface area. According to the scale, you might expect a 600-700 gm reduction.Surgically, there are limits based upon the surgical technique employed. A certain mount of tissue must remain to preserve a blood supply to the nipple areolar complex (NAC). the further the distance between the anticipated position of the NAC and its current position the more limited the reduction.As always, discuss your concerns with a board certified plastic surgeon (ABPS). 

At 5’5 and 215 lbs,
your BMI is 35.5, which puts you in the obese range and high risk for complications
after surgery.  You will need to lose
weight prior to the surgery.  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
and the ability to breast feed are maintained. 
Best Wishes,Gary Horndeski, M.D.

None of us can predict what decisions insurance companies will make regarding coverage for BR surgery or what documentation will sway their decision. BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered by most medical insurance providers.  If not, they may try to deny you based upon a lot of things such as lack of symptoms, lack of previous medical management, and lack of enough tissue that should be removed. The insurance companies will dictate the amount of tissue to be removed, not the PS.
Read your medical insurance certificate of coverage. Determine what medical information is required for your medical insurance company to issue a pre-authorization or predetermination of benefits for BR surgery. Then seek consultation with a board certified plastic surgeon who can evaluate your medical condition and history, discuss the pros and cons of this surgery as it applies to you, and help you in completing the paperwork required.  
Kenneth Hughes, MD, Board Certified Plastic Surgeon
Los Angeles, CA
 

You will definitely benefit from a breast reduction!I don't think your plastic surgeon will have any trouble removing at least 700 grams of tissue per side. Every insurance company is different, and each policy can differ as well, so I can't say for sure if you'll qualify under your insurance plan. Additionally, some insurance companies also demand that you first undergo physical therapy or massage therapy prior to the procedure in order to qualify. Lastly, most insurance companies will only pay for the procedure if a certain amount of tissue is removed based upon a woman's height and weight.  The heavier the patient, the more tissue needs to be removed. Best of luck to you!

From your photos and symptoms I would think this would qualify as a medically necessary operation, and it is likely that 600-700 grams could be removed safely.  Unfortunately however that is only a doctor’s opinion and has little to do with insurance coverage.  You’ll need to call your carrier yourself to find out exactly what their criteria are for coverage, and what would happen regarding coverage if you had surgery and the doctor wasn’t able to safely remove 600-700g (it’s impossible to know exactly how much can safely be removed beforehand, it can only be estimated, and removing excessive tissue during surgery just to meet an insurance company’s predetermined number could result in nipple loss).A visit to a plastic surgeon's office will help you to understand if you're a candidate for the procedure, and what aesthetic and/or functional outcomes are realistic in your particular case.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, always schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Best of luck,
Keith M. Blechman, MD
New York, NY

It appears from your photographs that you have at least 600 g of breast tissue that can be removed from each breast, however a physical examination is a much more accurate way to determine that.    Keep in mind that there are many other factors besides breast weight that go into the criteria to meet medical necessity according to insurance providers. The best place to start is with a consultation from a board-certified plastic surgeon. Best wishes to you.

Hello and thank you for the question and the photos. Your concerns and pain are common and real. The insurance industry has a policy of refusing surgery on somewhat made up rules and limits based on bmi. They will often require the patient to undergo weight loss,  physical therapy and exercises first, despite there being no evidence to show that such measures actually work. The only corrective measure for this is surgery. Insurance companies will dictate how much breast tissue needs to be removed in order for the insurance to be covered and not be considered "cosmetic". Again, it's a bit arbitrary how they decide the exact amount, however, it does tend to be severe leaving most women with very little breast tissue in the end. Your photos show very large breasts for your frame and there should be coverage. I know I sound cynical, but having done this for almost 20 years, I see a lot of good reasonable requests get rejected by insurance companies. You need to take the fight to them as they will not listen to us. It does depend on what type of insurance you have, and what the policy covers. Best to you. 

After reviewing your photographs it appears that a removal of between 700-800 grams per breast should take you from your G cup to a large C cup.  The removal of this amount of tissue from each breast should place you in a good position for the breast reduction procedure to be covered by your insurance carrier.  Be sure to seek the advice of a board certified Plastic surgeon and good luck with your procedure.  

Dear Dogmom2014,Hello and thank you for your excellent question.  You should be evaluated for a No-Vertical-Scar breast reduction technique.  Some people refer to this as the Bellesoma Breast Lift technique. Our technique provides an exceptional breast lift, upper pole fullness, relief from neck and back pain, and no vertical breast lift scar. It uses a woman’s OWN breast tissue to produce an internal suspension technique, without the need for a breast implant. It does not disturb the nipple, areola, or breast glands, so sensation and the ability to lactate is preserved. It uses 3D scanning of your breasts and body to design a procedure specifically designed for YOU, and you alone. Finally, for patients who desire breast enlargement, it can be combined with fat grafting. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

RealSelf100

America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 – 2018

BeautyAdvisor Top Contributor