Will Insurance Pay for a 16 Yr Old with 42DD Breasts to Get a Reduction?

She is only 5'4 1/2" and weighs 160 (at least 20 lbs would be her breasts). She has not grown physically in the last two years more than 1/2", so her chest looks grossly out of proportion to her body. She also is developing a hunchback and pain in her shoulders. She's also cheerleading this year and they are seriously getting in the way. Also, is there a doctor at Children's Mercy in Kansas City you could recommend?

Doctor Answers 14

Will insurance pay for a 16yo with 42DD breasts to get a reduction?

Thank you for your question! I hope that these answers help in making your decision. She suffers from juvenile hypertrophy of the breasts, which is typically treated by breast reduction. It is not uncommon to have the symptoms that you describe such as neck/back/shoulder pain as well as infections/rashes and shoulder grooving, especially in teenagers once her breasts begin to fully develop.
Once one begins to have the symptoms that you state above, consideration for a surgical procedure to ameliorate your symptoms, assist with self esteem, and allow you to get back to physical activities in your youth should be done. Given her symptoms, she would be an ideal candidate. She must first discuss with her parents and pediatrician, and then consulting with a plastic surgeon for evaluation and examination to assist you in deciding if this would be the right thing for her. Your surgeon will also go over what to expect as well as the risks and benefits of the procedure. Overall, her symptoms should be ameliorated almost immediately and hopefully give her more self confidence and an increased activity level. Her breasts may still continue to grow over the next several years, but it is certainly reasonable to consider this at this age with the issues that you are having. I hope that this helps! Good luck with your decision!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Insurance and breast reduction

Reductions can be done at 15 with parental consent, and the proper medical clearances. Insurance coverage is a hit or miss depending on the carrier.  Usually having symptoms related to breast size is necessary for insurance coverage. Getting it covered though is very difficult. Insurance companies wont tell anyone how much tissue needs to be removed to qualify for coverage. Then if the surgeon is 1gram off they deny coverage after the fact. Insurance companies make money by denying coverage. For that reason most plastic surgeon will likely ask for payment up front.  Breast reductions are the most gratifying operations because years of neck, back and shoulder pain are gone within days.  The final size result depends on your starting size. If you start larger then you will likely end larger. It is not possible to choose a size with any real accuracy. The main reason is that the procedure removes breast tissue but leaves enough tissue to preserve the blood supply to the nipple and areola. Thus more tissue needs to be left behind to ensure nipple viability. The nipple and areola is constantly being accessed during the operation.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 34 reviews

Breast Reduction for 16-year-old?

Thank you for the question. I'm glad to hear that your daughter has your support;  this  this will be very helpful to her.

It sounds like she is dealing with juvenile breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for the frame causing  both physical and psychological distress.

As   she thinks  about  breast reduction surgery make sure  she does her homework and understands the potential risks and complications associated with  the procedure.  Make sure she also understands that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

On the other hand, breast reduction surgery is one of the most patient pleasing operations we perform and I think that for the right teenager (enough symptoms) it may be an excellent option (regardless of the age).
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. Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Breast reduction

Every insurance company has different requirement in order to cover breast reduction. E age could also be a factor. 16 is the youngest that i will perform a breast reduction.

David L. Abramson, MD
New York Plastic Surgeon
4.1 out of 5 stars 12 reviews

VIDEO (Click here) Breast Reduction and insurance coverage.

It is best to go in for a consultation and have the surgeon draft a letter of predetermination of benefits to your insurance carrier to help ascertain your level of coverage.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Breast reduction coverage for a 16 year old

What insurance companies deem necessary for surgery is not always what we as plastic surgeons think is necessary.  In all cases a consultation with a board certified plastic surgeon is required.  The surgeon will then submit his or her recommendations to the insurance company.  Many times supporting documentation is necessary to substantiate the medical reasons for the surgery to meet the insurance companies criteria.

Randy Proffitt, MD
Mobile Plastic Surgeon
4.6 out of 5 stars 23 reviews

Will health insurance cover breast reduction?

In your situation, probably yes, but the best way to find out is check the provisions of your policy (online or by phone), and visit her primary care physician for referral to a plastic surgeon.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

Breast Reduction Covered by Insurance

Yes, sometimes insurance will cover these types of procedures depending on the Insurance company and the severity of the case. I would recommend contacting your insurance company to get their requirements, as they vary greatly between companies.

Robert N. Young, MD, FACS
San Antonio Plastic Surgeon
4.6 out of 5 stars 70 reviews

Breast reduction is medically necessary

Breast reduction, when medically necessary, is covered by most insurance plans.  This will require you doctor to submit information, and even photos, to the insurance company to receive a pre-determination of coverage.  From your description, breast reduction may be medically necessary in this individual.  I suggest you see two or three plastic surgeons for opinions.

Daryl K. Hoffman, MD
San Jose Plastic Surgeon
4.6 out of 5 stars 16 reviews

Breast reduction

It is certainly possible that your daughter may be a candidate for a breast reduction. But without seeing her it is impossible to say.  You can check with your  insurance company regarding coverage.

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