Will Insurance Cover my Breast Reduction, Will They Sag Again After Weight Lost?

I am 260, 5'4 size 42G breast. I have degenerative arthrits in my that cause severe pain, along with numbness and tinglining in my arm and hand. I am a nurse so this sometimes make it difficult to even work. Exercise is also difficult because of the shooting pain in my arms. Will insurance cover my breast reduction? If I lose weight after the procedure will the sag or will they get smaller?

Doctor Answers 5

Overweight and want a breast reduction

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You may be putting the cart in front of the horse.  Try loosing the some weight first then you will be a much better candidate for a breast reduction and will definitely reduce your risks for complications and healing problems.  

Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast reduction and obesity

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I think you are a bit heavy to undergo a breast reduction. You are better off at this point going on a diet and losing weight first.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast Reduction at 260 lbs

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  The breast reduction would likely give you some relief, but your weight may disqualify you by some insurance carrier standards.  If you were to lose weight after surgery, the breasts would likely droop some, but this depends upon the amount of wieght lost and the amount of fatty tissue in your breasts. 

Breast reduction

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Hi! Thank you for your question

I am Dr. Speron, a proud member of both the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS).  I am also certified with the American Board of Plastic Surgery.

Because breast reduction is usually considered medically necessary, your chances of getting insurance coverage are good. But you must be sure to follow all the procedures set forth by your carrier’s policy. Your surgeon will need to take photos of your breasts, and detail your physical symptoms caused by enlarged breasts in a letter.

If you lose weight after your breast reduction, you will likely lose some volume in your breasts. In some women the skin shrinks along with the breast tissue, and you are just left with smaller breasts. In other women, the skin does not shrink and the breasts look droopy because now there is less breast tissue in the same size skin. It would be best to be as close as possible to your long-term “stable” weight before the surgery. However you can also have a revision to fix any drooping that may have developed.

I have provided a link below for additional information as well as a lot of before and after pictures.

If you have any further questions, please feel free to call us at 847.696.9900 for a private consultation.

Best of luck and have a great day!
Dr. Speron

Sam Speron, MD
Chicago Plastic Surgeon

Insurance coverage for breast reduction

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Every insurer has its own set of criteria. In NY, many require documented conservative management for anywhere between 3-12 months, which would include neurology workup, spinal x-rays, PT, OT, chiropractic, analagesics, etc. The qualifiers in your case are twofold: 1/your weight, which is a disqualifier for Oxford, as an example, and 2/whether your numbness and pain pattern is unrelated causally to the breasts. See a board certified plastic surgeon in consultation who performs this proedure frequently and whose staff should be able to assist you in the authorization process. If you lose weight postoperatively, the breasts can both sag and get smaller so it would be advisable to start a weight loss program first and have surgery when your weight is stabilized.

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.