Would I qualify for an insurance covered Breast reduction? (photos)

Hi! I have always been chesty. I was a 14 year old 85 lb with a DD chest. At my heaviest(last year) I was 190 with a 36DDD. I am now 140 and STILL a 34DDD. I really want to get to a C because they are way to big for my size! And losing weight won't make them shrink. My physician has talked about a Breast reduction because I have shoulder curves from the heaviness in my bra and back and neck pain, headaches which I have been prescribed muscle relaxers and codeine!

Doctor Answers 5

Would I qualify for an insurance covered Breast reduction?

Thank you for your question.  Each insurance company has different prerequisites for a breast reduction so you'd have to check with your plan.  Based on the size of your breasts and associated symptoms, you appear to be a good candidate for a breast reduction.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck!

Dallas Plastic Surgeon
5.0 out of 5 stars 19 reviews

Would I qualify for an insurance covered Breast reduction?

Based on your symptomatology you will very likely derive symptom improvement from a breast reduction. Many Insurance companies also base their criteria on the amount of tissue that can be removed from each breast.  Sometimes, they require a minimum of 500 grams per breast (a little over a pound per breast).  Some insurance companies will approve slightly less or require slightly more based on your height and weight.  Your board certified plastic surgeon and staff will be able to determine whether or not you qualify.  Hopefully this helps.  Best of luck.

J. Douglas Robertson, MD, FACS
Montgomery Plastic Surgeon
5.0 out of 5 stars 3 reviews

Would I qualify for an insurance covered Breast reduction? (photos)

Thank you for your question and the information along with photo.  You qualify for most of the guidelines that insurance companies are looking for, so long as everything has been documented by your doctor.  You have heavy breasts, which remained heavy despite weight loss, you have deep bra strap grooves, you have been taking pain medication, etc.  But, insurance companies each have their own set of guidelines and your plastic surgeon's office needs to help you inquire from your insurance company what guidelines your policy dictates.  Hope that helps.

Ruben B. Abrams, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

#breastreduction #insurance

Every insurance company has different rules for approval. Some do not even cover breast reductions. I would suggest you call you insurance carrier and also contact a board certified plastic surgeon with experience in breast reductions. The office may be familiar with the rules for your specific carrier.Breast reductions are also often done as a cosmetic procedure when insurance is not an option. Check for pricing as lately we have seen that patients with a high deductible can actually save money by having breast reduction surgery as an out of pocket option.

Jack Peterson, MD
Topeka Plastic Surgeon
4.5 out of 5 stars 41 reviews

Would I qualify for an insurance covered Breast reduction?

I am sorry to hear about the problems your disproportionately large breasts cause.  Based on your  description, you sound like you may be an excellent candidate for breast reduction surgery; of course, much more information is necessary to provide you with definitive advi Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, 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. Also, for many insurance companies, the closer you are to your long-term ideal weight, the better. This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. Also, prepare to be persistent when dealing with health insurance companies. I hope this, and the attached link, helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 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.