Will Insurance Cover Breast Reduction for D Cup Breasts?

Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive.

Thank you for your question.
It is hard to say if you are a good candidate without an in person evaluation. It seems like you might be. Your health insurance may cover the cost depending on your benefits. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

This procedure is commonly covered by insurance though insurance
criteria are becoming more and more restrictive. Although we do not accept
insurance, our staff will assist you in obtaining pre-authorization so that you
can attempt to be reimbursed for out of pocket expenses

Large breasts (macromastia) or breast hypertrophy can occur in a
variety of conditions (family trait, post pregnancy, excessive adolescent
growth). In general when the excessive breast size causes functional problems,
insurance will generally pay for the operation if more than 400 – 500 grams are
removed from each breast dependent on your individual insurance company
requirements. These problems may include neck pain, back or shoulder pain,
hygiene difficulty, and breast pain. Other problems which are less likely to be
covered by insurance include skin irritation, skeletal deformity, breathing
problems, psychological/emotional problems, and interference with normal daily
activities. Pre-authorization by the insurance company is required prior to
surgery, and the process takes approximately one month. Each insurance policy
has different guidelines and exclusions.

Depending on your situation, insurance may be able to subsidize the cost of breast reduction. Some breast reduction coverage requirements where I practice in Ontario include your current cup size, the amount of breast tissue removed during surgery, unsuccessful experiences with alternative treatments and medications, as well as recommendations for breast reduction from other specialists, such as chiropractors and neurosurgeons.Please see an experienced board certified plastic surgeon to find out whether you are a suitable candidate for breast reduction first. Best of luck.

Hello! Thank you for your question.  It is a safe procedure, in which your plastic surgeon will reduce the amount of breast tissue, reshape your breasts, raise the nipple-areolar complex to its appropriate position (possibly making the size smaller, if needed), and ultimately ameliorate the possible complaints that you do have for the reason that you are having this procedure (e.g., neck/back pain, migraines, rashes/infections, shoulder grooving, etc).  Your complaints and physical findings will be important for the authorizationIt would be in your best interest to have a mammogram prior to the procedure for screening prior to this procedure, as the architecture imaging of your breast will slightly change afterwards. Well known data exists that having a breast reduction will in fact lower your chance for developing breast cancer, simply because the amount of tissue will be less.Consult with a board-certified plastic surgeon who will discuss the procedure with you, examine, and assist you in determining if this is the right procedure for you.  Voice your complaints - your insurance will likely require a detailed description of your history and complaints as well as photo and an estimate of how much tissue will be removed.  You should give a description of the therapies that you have done to ameliorate your complaints thus far.  Any other notes from other physicians is helpful.  It would also behoove you to discuss your issues yourself with your insurance carrier.  Hope that this helps!  Best wishes!