How long is the breast reduction process and would I benefit?

Question

I am 5'6 and 160 lbs. Not overweight but I have size 38 DDD breasts. I am really wanting to get breast reduction surgery but I am wondering how long it takes to get approved and all of the pre-surgery process and how long it takes. Do you think I would be a good candidate in your opinion. They are very unporportional to my body and I wake up every day wanting a reduction.

Marie E. Montag, MD · Answer

The breast reduction process overall involves a
number of steps.The first and most
important to get it rolling is the initial consult with a plastic surgeon.At that visit, you will explain your
situation and symptoms, be examined and lean about the details of the procedure
and the postoperative course.Pictures
are usually taken at that time and your surgeon will use that information to
write a letter to your insurance company to see if they will cover it.This can take anywhere from six to eight
weeks in some cases.Once you have been
approved, or if not approved and you would have been given fees, it is time to
schedule surgery.Most surgeons can get
you into the operating room within three to four weeks, depending on the time
of year and your degree of flexibility.The surgery itself usually takes between 1.5 to 3 hours depending on if
your surgeon is alone or if he or she has an assistant.In most cases this can be performed on an
outpatient basis so you can go home after about two to three hours recuperating
in the recovery room.You are usually
seen back the next morning or at least during the first week and then every
couple of weeks as you recuperate.Any
external stitches are usually removed between two and three weeks after
surgery.You have to wear a heavy
supportive sports bra for three to six weeks and limit your physical activities
for at least three to four weeks.Before
going back to strenuous exercise and heavy lifting it is probably four to six
weeks, depending on your healing.Most
people take off about two weeks from work depending on the job.The person who would benefit from a breast
reduction is one whose breasts are sufficiently enlarged out of proportion to
the rest of their body so that they experience symptoms.These symptoms are very predictable and
include back, neck and shoulder pain, shoulder grooving from bra straps, pain
in the breasts with activity that limits activity, rash under and between the
breasts from the constant moisture, postural changes, and headaches.These symptoms will very reliably get better
when we reduce the size of the breasts down to be in proportion with the rest
of your body.If you experience any of
these symptoms then a breast reduction would be very beneficial to you.

Gary M. Horndeski, MD · Answer

At size 38 DDD each 200 grams of tissue
corresponds to 1 cup size change. 
Insurance companies will authorize breast reductions based on two
factors.  One, you must have symptoms
such as neck, back and shoulder pain secondary to large breasts.  Second, you must meet a weight requirement to
satisfy the insurance company.  In your
case, they may require excessive reduction and you may not qualify.  The most frequent complaint after breast
reduction is breasts disproportionate to the body size.  I recommend a new technique called The
Ultimate Breast ReductionTM. 
This technique reshapes the breast tissue creating upper pole fullness,
elevates them higher on the chest wall and more medial to increase your
cleavage.  This technique avoids the ugly
vertical scars of the traditional technique, maintains nipple sensation and the
ability to breast feed.  Pain is relieved
by transferring the weight of the breast to the underlying muscle, not by
excessive reduction.Best Wishes,Gary Horndeski, M.D.

Kenneth Dembny, II, MD · Answer

If
you experience any neck, back, or shoulder pain, bra strap grooves, skin
irritation or infection, poor posture, decreased activity or other functional
problems that are related to large breasts then breast reduction surgery may be
covered under your insurance. Insurance coverage depends upon specific terms of each
policy, and individual patient factors/symptoms.More
frequently, however, breast reduction is written as an exclusion in many
insurance policies.

Patients seeking insurance coverage for breast reduction surgery
(performed for symptomatic breast enlargement) must have their plastic surgeon
obtain written pre-authorization of medical necessity from the insurance
company. Insurance policies vary
tremendously in their extents of coverage, requirements, documentation, and
exclusions. Most insurance policies have specific requirements for minimum
amounts of breast tissue that need to be removed. Some insurance policies require
overweight women to lose weight prior to surgery. Still other policies may
require an orthopedic evaluation of back pain, or a trial of physical therapy
and anti-inflammatory medication prior to authorizing surgery. And, many insurance
policies specifically exclude breast
reduction surgery, even if it may be medically indicated. Some of these
requirements may seem unfair or not make sense, but if these specific
provisions are written into a patient’s insurance policy they must be followed
if insurance coverage is expected. As
all policies differ, it is important to check with your insurance company for
the specific documentation you are required to file when seeking a medical
necessity determination.

Many
insurance companies are now requiring that some or all of the following
criteria, or other similar criteria, be met in order to be considered allowable
for coverage for breast reduction.

1). The
patient has significant symptoms, documented in their medical records, which
interfere with activities of daily living, including:

pain
in the upper back, neck, and shoulders which is of long-standing duration and
increasing in intensity, and/or

Persistent,
non-seasonal submammary skin rash/inflammation/irritation (intertrigo) which is
unresponsive to local hygiene and topical anti-infective therapy, and/or

Ulnar nerve paresthesias resulting
in pain and/or numbness in the arms and/or hands.

2). The
physical exam must document:

Significant
shoulder grooving or skin ulceration, and

Obvious
breast hypertrophy, and

Sternal
notch-to-nipple distance > 28cm for women > 5’2” tall, or >
25cm for women < 5’2” tall, and

Physical exam findings consistent
with symptoms related to mammary hypertrophy.

3). There
must be a failure of (sometimes documentation is required) a comprehensive
conservative treatment measure, including:

A
minimum of 6 weeks of physical therapy for the back, neck, and/or shoulder pain
including a maintenance home exercise program, and

Appropriate
support bra with weight distributing straps, and

Anti-inflammatory
medication, unless contraindicated, and

Symptomatic
measures, including application of heat and cold, and

Appropriate local hygiene and
topical medication for intertrigo.

4). The documented
Body Mass Index (BMI) must be < 30, which is below the level considered
“obese” according to the guidelines of the National Institutes of Health (NIH)
– National Heart, Lung, and Blood Institute (NHLBI) Clinical Guidelines on the
Identification, Evaluation, and Treatment of Overweight and Obese Adults.

Following
your evaluation, your surgeon would estimate how much tissue needs to be
removed; and usually this is discussed during the consultation. Your plastic
surgeon would then submit a letter to your insurance company documenting the
history and exam findings and request prior authorization for breast reduction
surgery. The entire process may take 4-8 weeks before an answer is obtained
from the insurance company. If breast reduction surgery is approved –great; I
am sure you will feel much better following your surgery. If not, then there is
usually a method by which patients can appeal the decision.

Breast
reduction surgery is considered “cosmetic” (patients pay out of pocket) for
those individuals who are asymptomatic or do not meet the criteria for medical
necessity set forth by their insurance company.

The
satisfaction rate following breast reduction surgery, for women who suffer from
symptomatic breast enlargement, is very high. Women experience improvement/resolution
of chronic aches and pains, and usually have increase freedom of movement and
activity. Many say, “I wish I would have done this years ago.”

It sounds
as if an evaluation for reduction surgery is certainly appropriate for what you
describe about yourself. I would recommend you see a plastic surgeon to discuss
your options and see if you qualify under your insurance plan.

I hope this
helps. Best wishes. Ken Dembny

Steven Wallach, MD · Answer

Each insurance company is a bit different and some will approve it by phone, some require a letter and photos, and some want medical records reporting conservative management failure.

Tom J. Pousti, MD · Answer

Based on your breast cup size alone, you may be a good candidate for breast reduction surgery. However, much more information is needed to determine whether you should proceed with surgery, and if so when ( timing).
“Typical” patients who present for breast reduction surgery are women who have disproportionately large breasts, causing problems such as neck/back/shoulder discomfort, postural changes, bra strap grooving, skin irritation/rashes under the breasts, and/or difficulty with activities of daily living and/or exercise etc. There may be both physical as well as psychosocial “stress” caused by the disproportionately large breasts.
Reducing breast tissue mass and elevating the breasts on the chest wall tend to improve or alleviate many of the symptoms associated with the disproportionately large breasts.
Patients considering breast reduction surgery should also consider the potential downsides (risks/complications) associated with the procedure as well. Poor scarring, for example may be associated with the procedure.
When the time is right, I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.
Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.
I hope this, and the attached link, helps.

Peter E. Johnson, MD · Answer

If you are referring to insurance predetermination for breast reduction it can depend on your state and particular health plan. Blue Cross in our state can take up to 60 days to respond, an HMO can very quick.

Edward J. Domanskis, MD (in memoriam) · Answer

It really depends on your insurance carrier. We can submit your photographs with short history. Sometimes it is not approved. The surgery is done as an outpatient with about a two week recovery.

How long is the breast reduction process and would I benefit?

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