I am 21, 5' 9", and 200 pounds. My bra size is 38 DD, I would like to be a C. Would Insurance Cover my Breast Reduction?

I am 21, 5' 9", and 200 pounds. My bra size is 38 DD, I would like to be a C. I get these rashes between my breasts and my shoulders hurt from my bra. My left breast is also a lot bigger than my right, which makes it very hard to find bras that fit correctly. I know most women have one bigger than the other, but it seems like there is a big difference in the size of mine.

Doctor Answers 4

Breast Reduction Candidate

Candidates for #BreastReduction surgery are women who wish to have smaller #breasts to achieve a more proportional appearance or to alleviate physical discomfort. Breast reduction can correct symptoms from excessively #largeheavybreasts that may cause the inability to do certain exercises, or create back, shoulder and neck pain, poor posture, bra-strap shoulder indentations and chafing or rashes under the breasts. Women experiencing these discomforts may benefit from Breast Reduction, also called #ReductionMammoplasty.
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 i company requirements. However, insurance criteria are becoming more and more restrictive. Pre-authorization by an insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions. Although, we do not accept insurance, our staff will assist patients in obtaining a pre-authorization so they may attempt to be reimbursed for their out of pocket expenses.

Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Patinets refuse large reduction required by insurance companies

At 5;9 and 200 lbs, your body surface is 2.09 meters squared and Aetna insurance would require 1000 grams removal.  At size 38, each cup size corresponds to 200 cc and you would need a 5 cup size reduction.  This would reduce you to approximately a size A not size C.  If you have rashes then this meets the symptoms criteria but the volume removal would bemore than you desire.  Your alternative is not to use your insurance but self pay.  In conclusion, yes the insurance will pay for a breast reduction but the amount required is prohibitive.  This frequently occurs and the patient refuses surgery.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Breast reduction and insurance

You should check with your insurance company regarding their criteria for approving a breast reduction.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Reduction and Insurance Coverage?

Based on your description you may be a good candidate for breast reduction surgery; This operation is one of the most patient pleasing operations we perform. It will be in your best interests to achieve a long-term stable weight prior to undergoing this procedure..
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 are  consulting with  well-trained/experienced board-certified plastic surgeons.  

Also, be prepared to be persistent when dealing with health insurance companies.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

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.