Requirements for Breast Reduction?

Question

What is the criterion to be met for breast reduction surgery to be covered by Cigna? I have been seeing a chiropractor for a year with little to no improvement in my back and shoulder pain. The grooves in my shoulders from my bra are turning into open wounds and I have open sores underneath my breasts due to chaffing. I am size 40G (40DDDD) and my BMI is 36.

Christopher Pannucci, MD, MS · Answer

Hi riverblues,
I'd suggest making an appointment with a surgeon, and bringing the documentation from your chiropractor about multiple visits, plus any PT or PCP visits that discuss your issues as well.
Your surgeon can perform an evaluation, and estimate the amount of tissue that would be removed. Your surgeon would then send a copy of his/her note to your insurance, which would include your height/weight, photos, expected removal weight, and supporting documentation like your chiropractor notes. And then your insurance would make a decision.
If your insurance says no, the option to pay out of pocket is always there, too.
Hope this helps!
Best,Christopher Pannucci MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Daniel Barrett, MD · Answer

Dear riverblues,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jon S. Wilensky, MD · Answer

Undergoing a breast reduction procedure is a personal decision that is often made for medical reasons, such as alleviating physical discomfort or addressing health issues associated with large breasts. Here are some general requirements and considerations for breast reduction:1. Medical Evaluation:• A thorough medical evaluation is typically conducted to assess your overall health and determine if you are a suitable candidate for surgery.• Your plastic surgeon will review your medical history, current medications, and any pre-existing health conditions.2. Physical Discomfort or Health Issues:• Breast reduction is often performed to address physical discomfort, pain, or health issues associated with large breasts, such as back pain, neck pain, shoulder grooving, and skin irritation.• You may need to provide documentation of these issues and their impact on your quality of life.3. Stable Weight:• It's advisable to be at a stable and healthy weight before undergoing breast reduction surgery. Significant weight fluctuations can affect the long-term results.4. Non-Smoking Status:• Smoking can impair the healing process and increase the risk of complications. Many surgeons recommend that patients stop smoking for a certain period before and after surgery.5. Realistic Expectations:• Having realistic expectations about the outcomes of the surgery is crucial. Your plastic surgeon will discuss what can be achieved and the potential limitations of the procedure.6. Psychological Evaluation (in some cases):• In certain cases, a psychological evaluation may be recommended, especially if there are concerns about body image or mental health.7. Discussion of Surgical Technique:• Your plastic surgeon will discuss the specific surgical technique, potential risks, and expected outcomes. They will also explain the location of incisions and resulting scars.8. Recovery and Aftercare Planning:• Understanding the recovery process and aftercare requirements is important. This includes restrictions on physical activity, postoperative care for incisions, and follow-up appointments.It's crucial to have a thorough consultation with a skilled and experienced plastic surgeon to discuss your individual case, goals, and any concerns you may have. Your plastic surgeon will provide recommendations based on your unique anatomy and medical history.

Camille Cash, MD · Answer

Requirements for breast reduction covered by insurance will vary by policy.  From your description it sounds like you would benefit from a reduction.  A good place to begin is a visit to a board certified plastic surgeon near you for an examination and documentation of your concerns.  You can then contact your insurance carrier for clarification on criteria for coverage.  I've included a video I hope you find helpful.

Andrew T. Cohen, MD, FACS · Answer

You can call your insurance company and check. Most will authorize with an excision of 500 grams on each side and symptoms such as you are describing..rashes, skin break down, and a large size that you said you are. Best to also see a board certified plastic surgeon .

Good luck!

Andrew Cohen, MD

Good luck!

Andrew Cohen, MD

Scott C. Lindsay, DO · Answer

Hello and thank you for your question.
Call your Insurance company to find out the criteria and guidelines they require. Schedule a consultation with a board certified plastic surgeon to discuss your options. Bring any documentation you have from other physicians pertaining to your breasts ( pain. rashes, sores, shoulder grooving, etc.) Best of luck!

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