Will Insurance Help Pay for a Breast Reduction if I'm Worried About my Health? (photo)

I had a baby august '11 & have weighed 190 since (i'm 5'2) i'm now a 38H I've always had big breast. (in '09 at 5'2. 130lbs, 36DD/F ) They have been the main reason behind my self-image issues, my depression, problems sleeping, and back pain. I've tried losing weigh/t with no real results and most exercises hurt my back to no end. Am i exercising wrong? Should i push through and work out anyway? If they dont stop bothering me would insurance help me?

Doctor Answers 4

Insurance coverage for breast reduction

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Breast reduction is known to improve physical and psychological symptoms associated with having large breasts.  However, it has been getting more and more difficult to have insurance companies to cover for the surgery.  You will need documentation from your primary care physicians about your symptoms (back pain, shoulder pain, grooving, rashes, etc) that are caused by your breasts.  In addition, your plastic surgeon needs to remove certain amount of breast volume/weight in order to qualify for insurance coverage.  I think the first step would be for you to contact your insurance company to see whether your plan would cover for the surgery and ask whether you meet the criteria for the breast reduction surgery.  Good luck to you.

Breast Reduction and Weight Loss

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Weight loss would still be your best, frst thing to do.  Many individuals do better as a part of a supervised program (i.e. enlisting the help of a dietician, personal trainer, or the like).  If your large breast size is causing the psychological and physical problems you describe, then this would be a good investemnt long-term.


Insurance companies usually require removal of a certain amount of breast tissue, and some will also want to know your height and weight before they approve surgery.  This nis another reason to do your best with weight loss prior to surgery.

John LoMonaco, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 276 reviews

Breast Reduction

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Your photo shows relatively large breast, insurance possible would pay for a reduction if you have problems that are secondary to the large breast and have had them for a certain length of time. A consultation with a Board Certified Plastic Surgeon would help with determining if you qualify.  

Walter D. Gracia, MD
Fort Worth Plastic Surgeon
4.7 out of 5 stars 3 reviews

Breast Reduction and Insurance Coverage?

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Thank you for the question and an early “Happy Birthday” to your almost 1-year-old.

Based on your description you may be an excellent candidate for breast reduction surgery. As you know, it will be in your best interest to achieve a long-term stable weight prior to undergoing this procedure. You may be interested in seeking consultation with your internist, personal trainers, and/or nutritionists  who can potentially help you reach your goals.

Sometimes a procedure is covered through health insurance. 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.  Prepare to be persistent when dealing with health insurance companies;  ultimately your efforts will pay off. Breast reduction surgery is one of the most patient pleasing operations we perform.

When the time is right, make sure you are working with a well-trained/experienced board-certified plastic surgeon.

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.