Insurance Company Requesting a Total of 2000g Removed from my Breast - What Size Will I Be?

I am 5'8-200 lbs, breast size 36-38 E/F(according to Fredricks of Hollywood). The IC is requiring 1000 grams to be removed from each side. By the pic I've posted, what size do u think I will be after surgery? Do u think that the 2000 grams is to much and will leave me smaller than a full C. I've heard some people have more skin then tissue/fat(BALL IN SOCK EFFECT). In your experience, if there is not ENOUGH TO BE REMOVED will the IC still pay , giventhe fact that you can't get what u don't have?

Doctor Answers 12

Cup Size after Breast Reduction?

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Thank you for the question.

Congratulations on your decision to proceed with breast adduction surgery; it is one of the most patient pleasing operations we perform.

Unfortunately, no plastic surgeon is able to predict exactly what cup size you will be after breast reduction surgery. In other words, there is no correlation between grams of tissue removed and resulting cup size. Furthermore as you know, cup sizes vary depending on who makes the bra; this makes discussing cup size an inaccurate way of communicating your goals.  

In my practice I use goal pictures to communicate with patients.  With this technique patients are able to demonstrate what they are trying to achieve and what type of looks they do not like as well.   The patient's goal pictures are hanging on the wall, and allow for direct comparison.
 I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 

Best wishes.

Breast reduction: figuring out the final cup size

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Typically most insurance companies require a minimum of 500 gms per breast to be removed to trigger coverage.  With the average cup ranging from 150-200 cc, it is probable that this will produce a 2-3 cup reduction in size. However, this is only an estimate.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Setting A Gram Removal Does A Disservice To Patients

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Unfortunately, there are still a few insurance companies that require a certain amount of breast tissue removed during a breast reduction, but usually it is 500g/side, so 1000g total.  I would double check with your insurance company, since I have never had a company request a minimum more then 500g.  That being said, your surgeon should do what he/she feels is right for you.  If that means taking less off then an insurance company wants, then you just have to be prepared for a fight afterwards with the insurance company. 

Insurance Company Requesting a Total of 2000g Removed from my Breast - What Size Will I Be?

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Your concerns are REAL. As you can read from the previous expert posters, there are no hard fast rules on payment. IT IS A ROLL OF THE DICE! Inmost cases the IC pays but there is NEVER a guarantee! Please discuss with your chosen surgeon. You do not want any surprises. I think you will be a mid to large C or even a small D. From MIAMI Dr. Darryl J. Blinski, 305 598 0091

2000 gram breast reduction will leave you too small.

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Insurance Coverage for Breast Reduction

80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2) Very big reductions (like from an F cup to a C cup) will usually be covered.

3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

7) Evidence includes letters from your internist, orthopedic surgeon, and/or chiropractor stating that breast reduction will relieve your symptoms.

8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9) Don't give up. If the first request is denied, demand an appeal.

10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Insurance issues and breast reduction

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I can't tell you for sure what size you would be, probably a mid C.  The way the insurance company determines how much tissue to removed is needed is with something called the Schnur Scale.  This calculates the body surface area.  For your height and weight I calcullate your required resection to be at least 900 grams per side.  I think you will fall into the small C range.  Good luck.

Breast reduction and insurance coverage

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Based on you height and weight, your BSA is 2.10. This requires removal of 800gm/breast. This might give you a B/C cup. I believe this would require too much tissue removal to give you apropriately sized breasts for your height and weight. Based on the one frontal photo sent, I would not remove more than 500-600gm. Good luck. 

Breast Reduction Criteria

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Every insurance company has different criteria for breast reduction.  To give you a better prediction about resulting size after surgery, it is important examine you in person.  However, looking at your pictures, it is likely that you may be in the "C" range after surgery, but it is hard to tell just from the pictures.  

Good luck.

Breast reduction and weight requirement

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To accurately predict how much breast tissue weight will be removed without an exam is difficult even when you have the exam let alone only seeing pictures.  Remember don't jsut let the goal be removing the weight, obvioulsy that will be done, but you want to maintain a nice shape and volume to accompany your frame.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Insurance Coverage of Breast Reduction

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Insurance coverage of breast reductions is virtually always accompanied by a requirement to remove a certain weight of tissue based on BSA.  These thresholds need to be met or insurance cos. can and will deny coverage.  It is impossible to state with certainty but my best guess is that your post-op cup size would be in the range of C/D with a reduction of 1000 grams/breast.

John Whitt, MD (retired)
Louisville Plastic Surgeon

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.