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!

         Your symptoms
suggest that you would benefit from breast reduction surgery. This procedure
has the potential to improve quality of life and has long term health benefits
as well.

 

         Most patients with
breast enlargement complain of difficulty with back pain, shoulder pain, neck
pain, rashes and pain within the breasts themselves. They often have decreased
exercise tolerance and as a result gain weight elsewhere. They have difficulty
finding clothing that fits properly and they feel that people stare at them.
This adversely impacts their self image, self esteem and self confidence.

 

         Correction of breast
hypertrophy is a life changing experience. Symptoms improve, clothing fits
properly, exercise tolerance improves, patients lose weight elsewhere and self
esteem improves following this procedure.

 

         Each insurance
company has its own criteria for coverage of breast reduction. In some cases,
it may not be covered, in other words it may be a contract exclusion.

 

         In most cases
approval of the procedure is dependent upon several variables. Most companies
require documentation of symptoms and physical findings, they require a minimal
amount of breast tissue removal, and they require failure of conservative management.


 

         If you’re
considering breast reduction surgery, consultation with a board certified
plastic surgeon is appropriate. Your surgeon will be able to evaluate your
situation and write a prior authorization letter to your insurance carrier. 

It is very likely that your procedure would be covered but to be sure it is best for you to seek evaluation and examination by a surgeon who can then prepare a letter of predetermination of benefits to your insurance carrier.  

Every insurance plan has their own unique criteria on whether they will
cover a breast reduction. More and more, we are seeing plans where a
breast reduction is not a covered benefit. If it is a covered benefit,
some insurance plans set a minimum required amount of tissue to be
remove in order to met their threshold for coverage. Some set the amount
in relation to your BMI (height and weight). Others require extensive
medical records documenting neck pain, back pain, and history of rashes.
The other alternative is to opt for a breast reduction as a self-pay
option. Start by visiting with a board certified plastic surgeon to
learn more about your options.Best wishes,Dr. BasuHouston, TX

Reductions can be done as early as 15 with parental consent, a proper medical clearance and breast growth that has stopped. Insurance coverage is a hit or miss depending on the carrier.  Usually having symptoms related to breast size is necessary for insurance coverage. Getting it covered though is very difficult. Insurance companies wont tell anyone how much tissue needs to be removed to qualify for coverage. Then if the surgeon is 1gram off they deny coverage after the fact. Insurance companies make money by denying coverage. For that reason most plastic surgeon will likely ask for payment up front.  Breast reductions are the most gratifying operations because years of neck, back and shoulder pain are gone within days.  The final size result depends on your starting size. If you start larger then you will likely end larger. It is not possible to choose a size with any real accuracy. The main reason is that the procedure removes breast tissue but leaves enough tissue to preserve the blood supply to the nipple and areola. Thus more tissue needs to be left behind to ensure nipple viability. The nipple and areola is constantly being accessed during the operation. See a board certified plastic surgeon for specifics on your treatment.

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Thank you for the question.

Based on your description, you may be an excellent candidate for the breast reduction procedure; it is one of the most patient pleasing operations we perform.

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  working with a well-trained/experienced board-certified plastic surgeon.

Good luck!