Be real. What are the odds of insurance coverage? Assume I can choose any insurance right now. I know the criteria for most.

I've done incredible amounts of research on Breast Reduction. I *need* one. Post-partum 4 months, 5"2 173 lbs, paresthesia in left shoulder (due to ToS??), numb inner arms, shoulder grooves, neck/back/shoulder pain, lower back pain, possible slight lordosis, potential IBS due to breasts weight, breast size 32FF, but still breastfeeding (transitioning to formula due to pain and need of surgery, allow 6 mos. for change, pre-preg. 32DDD or E.) Did physical therapy; was told surgery was necessary.

Doctor Answers 7

Insurances do cover reductions routinely

if minimum excisions can be met and the policy is not a private companies managed by an insurance company as those companies have final say and they always call it cosmetic.  If your insurance is not managed by a private company, your surgeon should be able to tell you if your breasts will qualify.  And this is after you've 'dried out' from breast feeding (cessation at least 6 months and no discharge from nipples).  So when you've gone 6 months from breast feeding, find a surgeon who can help you determine if you qualify.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Insurance coverage for breast reduction #plasticsurgery

Assuming that breast reduction is not excluded from your individual policy, then approval really comes down to how much breast tissue can safely be removed in order to satisfy the per-breast resection weight requirements of your individual policy. Most insurance company's refer to the Schnur Table to describe this weight. Your surgeon will seek pre-authorization for the procedure before scheduling the surgery.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Post Pregnancy Breast Reduction

Thank you for your question.  It is very likely that you are a good candidate for a breast reduction procedure based on your description.  And the even better news is, it is a great operation that really helps people.  Symptoms improve, but so does self confidence and body image.

The question of insurance is more complicated.   You should be evaluated by a board certified plastic surgeon at least 4 months after breast feeding.  The surgeon, and his office staff, will then be able to give you a better idea what your options are.  Over the years it has become more and more difficult to have this procedure covered, but it still can be in some cases.  Good luck.

Douglas L. Vander Woude, MD
Grand Rapids Plastic Surgeon
5.0 out of 5 stars 5 reviews

Insurance Coverage of Breast Reduction is Ending


The pendulum is swinging back to less coverage of this controversial surgery.  There is very little and now fairly old data to suggest that macromastia is a substantial cause of quality of life issues, at least by itself. (IBS and macromastia is a new one I've never heard of.)  Whether it does or it doesn't, it has been too widely abused and is going on the endangered species list for insurance companies.

Well trained, highly skilled surgeons that specialize in breast surgery are not on any insurance companies providers lists anymore, so what you'll get is a less competent surgeon doing your surgery. Much better to start thinking about financing your surgery from reputable companies that specialize in cosmetic surgery loans: Care Credit, Prosper, and Alpheon Credit. 

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

Breast Reduction

You sound like an ideal candidate for breast reduction and would probably experience a dramatic improvement in your symptoms. But asking us to tell you your chances of insurance coverage is like asking us to turn on our crystal ball. Insurance companies do not like this procedure and over the years have made getting coverage more and more difficult. After you have stopped breast feeding entirely, let another 4 months pass and then see an experienced consultant for an exam. The doctor will then communicate with your company to see if you fit their specific criteria. About 75% of my patients pay cash, just like a breast augmentation patient does, because they do not meet the unrealistic criteria of their insurance carrier. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Be real. What are the odds of insurance coverage? Assume I can choose any insurance right now. I know the criteria for most.

I am sorry to hear about the problems your disproportionately large breasts cause.  Based on your  description, you sound like you may be an excellent candidate for breast reduction surgery; of course, much more information is necessary to provide you with definitive advice.

I have found that it is has become more difficult  to obtain  breast reduction surgery authorization from insurance companies;  for this reason, among others, many plastic surgeons are no longer working with insurance companies.

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.  

 Documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. Also, prepare to be persistent when dealing with health insurance companies. I hope this, and the attached link, helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

What are the chances of coverage for breast reduction?

Thank you for your question.  What you describe is certainly concerning and I would welcome a patient with your description for a face to face consultation.  During this visit the physician should obtain a comprehensive history and perform a physical exam.  After completing this it should be clear what can be achieved with surgery or if there are any non-surgical options.  If you are a candidate for surgery then when the patient is ready we move forward.  Many insurances cover this but depending upon the carrier there are discrepancies about the amounts needed to be removed to qualify (something your surgeon will have to estimate).   Always seek a Board Certified Plastic Surgeon who has experience with breast reduction.  See plenty of before and afters and do your homework.  Good luck.

David J. Wages, MD
Peabody Plastic Surgeon
4.8 out of 5 stars 23 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.