Would I be a good candidate for breast reduction surgery? And would it be possible for insurance to pay for it?

I am 5'5", weigh 110 pounds and have DD bra size. I have headaches everyday that are making me miss school and sports. I've started to get pain in my back and neck. Also running has become very challenging when I'm playing my sports.

Doctor Answers 7

Who is a candidate for breast reduction surgery

Hi and thank you for the question. Patients who seek out breast reduction surgery typically  have large, heavy breasts and have back pain, neck pain, grooves in the shoulders from their bra straps, and often get rashes under their breasts. A reduction will make the breast smaller and lighter, and usually improve or eliminate the patient's concerns. Without photos it's impossible for anybody in this forum to tell you whether you are a good candidate. No to D cup breasts are the same size. The best thing for you to do would be to have a consultation with a board-certified plastic surgeon in your area who can evaluate you and educate you about the procedure. Good luck to you.

Dr West


Newport Beach Plastic Surgeon
5.0 out of 5 stars 25 reviews

Would it be possible for insurance to pay for it?

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insuranc

Breast Reduction Covered by Insurance?

It is possible that your insurance may cover your breast reduction, however it will depend on your insurance policy. Different insurance companies have different requirements for approval. Some require that you document all that you have tried to alleviate your symptoms, such as; special bras, physical therapy, analgesics, etc. Many require that a minimum of 500 grams needs to be removed from each breast, that usually equates to a DD cup size, so you might qualify. Again it depends on your particular insurance policy. I recommend you see a Board Certified Plastic Surgeon who specializes in breast surgery, the office should be able to help you request authorization and help you each step of the way. Good luck!

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 68 reviews

Would I be a good candidate for breast reduction surgery?

I am sorry to hear about the problems your disproportionately large breasts have caused.  Based on your description, you may be an excellent candidate for breast reduction surgery; this tends to be one of the most patient pleasing operations we perform.



Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, 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. 



 

In regards to outcome of the planned procedure, the most important     decision you make will be careful selection of plastic surgeon. 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.

Be very careful with your decision-making. You will find, while doing your due diligence, that there are many different “specialties” who will offer their services to you; again, I strongly recommend you concentrate on surgeons certified by the American Board of Plastic Surgery.

 

 

Best wishes with your breast reduction procedure; hopefully you will be very pleased with the outcome of the procedure performed.

Breast reduction

You haven't posted pics so it is very hard to say.  I would recommend seeing a board certified plastic surgeon for a good exam and then they can send in the info to your insuance company to see if you qualify for a breast reduction.  You need to remove about 500 grams of tissue off of each breast to meet the criteria.   Good luck!

Andrew T. Cohen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 38 reviews

Am I a candidate for breast reduction?

Hi there, you have not provided your age but breast reduction is best performed after breast development is complete , or atleast at 18yrs of age.

If your breasts are DD cup, reduction will likely improve your neck and back pain, not sure about the headaches.

Your next step would be to meet with a board certified plastic surgeon, who will discuss the process with you and if he/she determines that you are a good candidate will then submit the documents and pictures to your insurance company . The insurance will likely also require supporting documents from your medical doctor reg. medical necessity, from physical therapist if you have had any. Once all these documents have been submitted to insurance , they will review it and let you know about the coverage.

Good luck !

Shwetambara Parakh, MD
Paramus Plastic Surgeon
5.0 out of 5 stars 12 reviews

Reduction

Without photos or an exam it is hard to determine your candidacy for a breast reduction. Based on your height and weight you might qualify, but insurance companies have strict criteria for coverage of this procedure including a minimum amount of tissue that needs to be removed which might not give you the result, size shape that you desire.

Barry M. Schwartz, MD
Weston Plastic Surgeon
4.0 out of 5 stars 4 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.