Will Insurance Cover my Breast Reduction at a D-DD?

You may be borderline in getting insurance coverage. Most insurance companies require a minimum of 500 grams of tissue needing to be removed from each breast, and that usually equates to a DD cup. Your best bet is to see a Board Certified Plastic Surgeon that specializes in breast reduction and have him or her give you an evaluation.Your surgeon will be able to advise you on your eligibility and help you get pre-authorization from your insurance. Good luck!

Insurance will cover breast reduction if you meet two criteria.  One, you must have symptoms from large breasts.  Second, you must have weight removed determined by your body surface area.  If you are only a D or DD, it is very likely that they will not cover you since the usually criteria is 500 grams minimum.  If you went down to size A or B, you would look inappropriately small and the scars would be highly visible.  Another alternative for you is to pay for it yourself.  There is a new technique called The Ultimate Breast Lift/Reduction, which transfers the weight of the breast to the underlying muscle to relieve pain.  Your breasts are reshaped and repositioned to increase upper pole fullness, cleavage and projection.  This technique avoids the ugly vertical scars and maintains nipple sensation and the ability to breast feed.

Best Wishes,

Gary Horndeski, M.D.

Insurance companies have different standards regarding coverage for breast reductions. A visit to a qualified plastic surgeon will answer your specific situation.

Definitely meet with a board certified plastic surgeon who can examine you carefully.  He or she will be able to better counsel you on the chances that insurance will cover your breast reduction.   Additionally, he or she may write a letter to your insurance company on your behalf to seek pre-authorization. 

Every insurance company has its own set of criteria that have to be met including: amount of tissue that should be removed based on your height and weight, documentation of symptoms, and sometimes they might require documentation that therapies such as physical therapy or massage therapy have failed to improve your symptoms. 

From your description, it sounds like you may be a very good candidate to undergo a breast reduction. 

Best of luck to you!

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. Basu
Houston, TX