Will I be able to get coverage by my insurance for a breast reduction at my age and weight?

I am 19 years old, 5' 4", and weigh 150 pounds. My breast size is a 36DDD, but it has been that size even when I was at 130 pounds. I have gained and lost significant weight over the course of high school and college and my breast size has remained the same, which makes me believe there size doesn't correlate with my weight. They cause severe back pain and limit my range of motion dramatically. I was wondering if I was too young or overweight to be considered for coverage, or if I might qualify?

Doctor Answers 4

Breast Reduction

Hello,Your age is not a problem, but your bra size and weight may be. You are above ideal body weight per insurance charts, and your bra size is not that big. Here's the real problem: most insurance companies are doing all they can to minimize their coverage on this surgery now, and are looking for any way to not pay, delay payments, or pay a fraction of what they should pay surgeons. Here's my recommendation. Rather then spend the next two years building a case that may never come to fruition with the insurance companies (primary care physicians, conservative therapy, weight loss, etc), or leading you to a surgeon that will do it but has little experience or skill, you should consider looking into financing this with a lending company - Care Credit or Prosper.  This will broaden your prospects for a surgeon you really want: an ABPS certified/ASAPS member surgeon that specializes in cosmetic breast surgery, who has a busy and highly reputable practice based on his good work.  The likelihood this type of doc takes any insurance is very low. Best of luck!

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

Will I be able to get coverage for a breast reduction?

Thank you for your question and this is a common question and a problem since insurance companies are making it more difficult to approve surgeries.  I think you are a good candidate for the surgery but you will need to see a board certified plastic surgeon who can help you through this process.  It will require that you try conservative therapy first and with good documentation and patience you may be able to get approval.  You may want to talk to your insurance company first to see what they will cover and what it will take to get it approved.  You may still grow but usually by 22 years of age you are at size you will be as an adult.  I would also consider the changes that will occur with pregnancy and nursing.  You not be able to nurse if you have this surgery so I would discuss this with your surgeon.

John D. Smoot, MD
La Jolla Plastic Surgeon
5.0 out of 5 stars 12 reviews

Breast reduction

You may have jouvenile breast hypertrophy which is covered by most insurance companies. A consultation will allow your surgeon to submit your case in order to determine if it can get covered.

Arian Mowlavi, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 41 reviews

Will I be able to get coverage by my insurance for a breast reduction at my age and weight?

I doubt your age or weight will play a role in the insurance company's decision. The only way to know if you are covered by the policy would be to see a surgeon for a consultation and exam and have the surgeon contact the company with the findings to see if you are approved. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 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.