19 yr-old, 5'4", 125 lbs, 32G considering breast reduction. Will it be covered by insurance?

I am 19, 5'4", 125 pounds, wear a 32G and am considering breast reduction. My neck and shoulders are always tight, my posture is bad, I have indents in my shoulders from my bra straps, and have terrible self confidence because of it. I also have trouble finding clothes that fit. Do you think my breast reduction could be covered by insurance?

Doctor Answers 4

Breast Reduction and Insurance Coverage?

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I'm sorry to hear about  the problems your breasts have caused, starting at an early age. Based on your description you may be an excelent candidate for breast reduction surgery.

Unfortunately,  online consultants will not be able to definitively state whether  any specific “insurance” will cover your  procedure. You will need to consult with board-certified plastic surgeons in your area and check with your insurance company regarding your specific policy.
  Undoubtably there will be some 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.  

Good luck with your  goals;  breast reduction surgery tends to be one of the most patient pleasing operations we perform.

Breast Reduction and Insurance Coverage

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Greetings. Just listening to your symptoms of neck pain, shoulder pain, bra strap grooves, self confidence and issues finding clothes that fit....as well as your body dimensions and bra size....I think you would be a great candidate for a breast reduction. Out of all the surgeries that are performed by plastic surgeons- breast reduction surgery has the highest patient satisfaction. Many insurance companies use something that is called the Schnur score. Using your body weight and height- your body surface area can be calculated. Depending on your body surface area- there is a scale which is called the Schnur score and dictates the amount of breast tissue that a plastic surgeon would need to remove, in order for your insurance to cover the surgery. In addition to this information, your insurance company may also want to have documentation from other providers such as your PCP, Ob/Gyn, Physical therapist or Chiropractor. All insurance companies are slightly different and there are some insurance companies or insurance policies who do not even cover breast reduction surgery. My advise would be to see a board certified plastic surgeon and once they evaluate you- they will try to put your case through your insurance company. You can also get in touch with your insurance company and see if breast reduction surgery is covered.

Helen Perakis, MD
Nanuet Plastic Surgeon

Insurance Coverage?

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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

Breast reduction coverage

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Based on your numbers, you would be a candidate for breast reduction surgery. However, check with your insurance company (many have online sites with detailed information, by procedure) as to whether and how much documented conservative management, including physical therapy, chiropractic, pain medication, etc., would be required to support your request for coverage.

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.