Do I meet the requirements for breast reduction? (Photo)

I am 5'3 150 pounds 36 DDD breast... I have extremely bad back and shoulder pain... I also slought over because my breast are so heavy and gives me bad posture. Last but not least I have bruises under my breast from my bra... As u can see my breast are very large for my frame... My insurance is united health care and i really don't know what to do to even begin the process... My desired breast size is a (A) cup and I am very serious I hate my breast!!!

Doctor Answers 9


You would definitely get this surgery covered if you have a half way decent insurance. Some are easier to deal with ( Blue Cross- Blue Shield ) than others . Try to pick the best surgeon and their experienced billers will help you.

Birmingham Plastic Surgeon
4.9 out of 5 stars 9 reviews

Requirements for breast reduction

There are several criteria that must be met in order for insurance to cover a breast reduction.  A consultation with a board certified plastic surgeon can help you understand what your options are, and if you would be considered an appropriate candidate.  Best wishes.  

Josef Hadeed, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 9 reviews

Do I meet the requirements for breast reduction?

It looks like you might well be able to get insurance to pay for a reduction. you might have to document failed treatment from chiropractic or physical therapy. United is not as bad to qualify for than some other carriers. Consult with a plastic surgeon that does breast reductions

William Lambeth, MD (retired)
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 6 reviews

Do I meet the requirements for breast reduction?

There is no requirement. If you want your insurance to pay for it, then you have  to deal with the company. Most insurances refuse to pay unless you bother them endlessly. Find a surgeon who will charge you a reasonable rate and pay for it, then you can easily have it done. The procedure can be done as an outpatient thus avoiding the costs of a hospital.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.1 out of 5 stars 11 reviews

Breast Reduction and Insurance

You appear to be a great candidate for breast reduction surgery. It can be challenging to get approval for coverage with insurance companies even if it is a covered procedure under your policy. They usually want documented proof of what you have tried to alleviate your symptoms, such as physical therapy, special bras, analgesics, etc. Seek a Board Certified Plastic Surgeon that specializes in breast surgery, your surgeon and his staff know how to deal with insurance companies and can help you through the process. If you should get denied, ask your surgeon to appeal your case, I have done this many times and have been able to get coverage in this way. Good luck!

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 63 reviews

Do I meet the requirements for breast reduction?

Based on your photos, symptoms and dimensions, it appears that you are an excellent candidate for breast reduction surgery. Consult with several plastic surgeons to find someone who will help you achieve your goals. Thank you for sharing your photos and question. Best wishes.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 157 reviews

Requirements for Breast Reduction

Requirements for Breast Reduction

If you are unhappy with the size of your breasts, if you think they are too large, if you have back, neck and/or shoulder pain because of the weight of your breasts, if you have difficulty finding clothes that fit properly at the top because of your breast size, if you get too much unwanted attention because of your breast size, if you cannot participate in sports or other activities because of the size of your breasts, or if you have chronic irritation or chafing of the skin under the breasts then you are a candidate for breast reduction. These are just a few of the more common reasons that women have breast reduction surgery performed.

The other consideration is who is going to pay for the breast reduction. If you are paying for the procedure yourself then there are no limitations on how much must be reduced, what your weight is or what types of therapy or other treatments that you’ve had prior to undergoing a surgical breast reduction.

Insurance companies over the years have become much more restrictive on approving breast reduction surgery. Many policies exclude it entirely but each policy will have its own unique criteria that must be met prior to the insurance company authorizing surgery. The best way to determine if your particular insurance policy will approve you for breast reduction surgery is to see a plastic surgeon who accepts your type of insurance and have a consultation. At that time an examination can be performed and details of the surgery can be discussed with you. The plastic surgeon will then need to submit a letter to your insurance company stating the reasons that you need to have surgery. They will then evaluate the information sent to them and make a decision based on their company policies. If your insurance approves the surgery, you may proceed. If not, you have the option of having the reduction surgery done as a cosmetic/self-pay patient. Often hospitals and anesthesiologists will offer discounts to patients who pay for their surgery prior to the procedure.

For the best results seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. They have a website listing all the certified plastic surgeons. Members of the American Society of Aesthetic Plastic Surgery will all be board certified in plastic surgery and have demonstrated an interest and competence in cosmetic plastic surgery as well.

Alexander G. Nein, MD, MS, FACS
Nashville Plastic Surgeon
4.4 out of 5 stars 25 reviews

Breast Reduction | Reduction Mammoplasty

Thank you for your question.

Yes, you may very well qualify for breast reduction surgery through insurance, but you need a consultation to find out.

To be sure, see two or more experienced, board-certified Plastic Surgeons for a complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery. He or she can also initiate the process of insurance qualification.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 143 reviews

Do I meet the requirements for breast reduction?

Thank you for the question. Based on the description, you may be an excellent candidate for breast reduction surgery. This operation tends to be one of the most patient pleasing operations we perform. I am sure that you will be able to find many well-qualified board-certified plastic surgeons in your area to help you with the breast reduction procedure as well as interacting with the health insurance company. I would suggest that you make sure your plastic surgeon is certified by the American Board of Plastic Surgery and can demonstrate significant experience and an excellent safety record when it comes to achieving the types of results you are looking for. 

When it comes to obtaining insurance coverage for breast reduction, there will likely be 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. Remember also when dealing with health insurance companies that you may need to be persistent. Best wishes. 

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.