Am I a candidate for breast reduction?

I am 5'5 and 190 lbs. I have been slowly losing weight. I wear a size 42F and i have had huge breasts since i was 15 and i am now 25. and I had a child and breast feed and my breast stayed the same size. I know I am overweight but I was wondering if I would be a candidate for breast reduction that would be covered by insurance or if it would be considered cosmetic?

Doctor Answers 5

Breast reduction coverage on insurance?

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Hello adchessmore, hope all is well and that you are having a great start to your weekend, thank you for your question.Insurances will vary with their criteria for coverage of a breast reduction so be sure to check with your insurance. I can't say for certain if your a good candidate since you would need a face to face consultation but a 42f seems large for your frame, and I believe you could be a good candidate for a breast reduction. My best recommendation to you is to seek a consultation with a board certified plastic surgeon to better review your case and make the best plan for surgery. Best of luck!

San Diego Plastic Surgeon

Breast reduction

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You sound to be a great candidate for a breast reduction surgery. Seek a nearby plastic surgeon and send pics and info to insurance company for authorization.

Am I a candidate for breast reduction?

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Thank you for the question. At some point, you may be an excellent candidate for breast reduction surgery. Generally speaking, the “ideal” patient for breast reduction surgery is one who presents with relatively large breasts in proportion to the remainder of her torso. These patients often present with neck, back, shoulder discomfort, bra strap grooving, postural changes, and occasionally with rashes/infections. This operation tends to be one of the most patient pleasing operations we perform.
Your next step may be in-person consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and make sure you feel comfortable with the quality and consistency of the work performed. During these consultations, you may be able to see other patients ( similar to yourself) who have undergone breast reduction surgery.
Sometimes breast reduction surgery is covered through health insurance. Whether or not your procedure will be covered will only be “answered” once you have communicated with your insurance company. Your plastic surgeon will be able to assist you with this communication process.
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. When the time is right, seek consultation with well-trained/experienced board-certified plastic surgeons.
I hope this, and the attached link, helps.

Am I a candidate for breast reduction?

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Thank you for your question.  Insurances will vary with their criteria for coverage of a breast reduction so be sure to check with your insurance.  Otherwise, as long as you're overall healthy and not a smoker, you should be ok.  However, the optimal aesthetic result would be achieved if you lost some more weight.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck!

Will insurance cover my breast reduction

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42F are big breasts and if they are causing you neck and shoulder pain then you can potentially have insurance coverage for your procedure.
First you would need to make sure that your insurance does cover breast reduction (some insurances have total exclusion for this procedure)
Secondly if you are having any medical issues due to your heavy breasts, like upper back or neck pain , you may benefit from seeing your medical doctor for evaluation and documentation purposes.
If have out of network benefits, then you can see any plastic surgeon of your choice who is willing to work with your insurance (The surgeon does not necessarily have to be in network), the surgeon would then send the notes and pictures to your insurance company to get pre-approval for the procedure.
Best of Luck!

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.