Good morning, Boobie64. You ask a good question, that is hard to answer: There are many breast reduction techniques, some that have more potential to leave a pleasing breast appearance than others. However, various physical exam and medical history factors may have an impact on the safety of each procedure, and a less "cosmetic" technique may be safer or more functional. As such, I would encourage you to look at before/after photos of your plastic surgeon to determine whether you feel the results of prior patients is "beautiful," or not, after determining what technique is recommended for you.At a 42H, it is not at all surprising that you have neck, back, and shoulder pain! A breast reduction generally provides instantaneous relief of these symptoms. And, most women with that large of a breast, discover a myriad of symptoms that resolve following a breast reduction. Each insurance company is different, and their policies change continuously, but most likely, with documented functional/medical issues and a 42H breast, insurance would coverage. However, you do need to consider that the extra attention required in trying to produce a more cosmetically appealing breast, as well as the skill and artistry of the surgeon, may or may not be found within your insurance's physician list.I hope that you are able to achieve the cosmetic results and relief of symptoms that you are looking for, and I hope you have an uneventful recovery should you decide to have a breast reduction. Best of luck! Dr. Ghafoori