Body Surface Area calculation

Question

Hello I have BC/BS and am looking to have a breast reduction covered by insurance. I see that they require a certain gm amount to be removed based on body surface area. I'm wondering if there are alternate ways to measure the body surface area because I think I may have more muscle than the average person. I know muscle doesn't weight more than fat but it's more dense so it's possible I'd have less body surface area than what the Dubois and Schuner scale predict? Thx

Elizabeth Kiwanuka, MD, PhD · Answer

It's great that you're exploring options for having a breast reduction covered by insurance through BC/BS. Understanding the criteria for coverage, including the requirement for a certain amount of tissue to be removed based on body surface area, is important.
Regarding your question about body surface area measurement, while the Dubois and Schuner scale is commonly used to estimate body surface area, it's true that individual variations in muscle mass and body composition can affect these calculations. Muscle is denser than fat, so individuals with higher muscle mass may have a different body surface area compared to those with higher fat mass, even if they weigh the same.
When it comes to insurance coverage for breast reduction surgery, it's essential to work closely with your surgeon and insurance provider to ensure that all necessary criteria are met. If you believe that your muscle mass may impact the accuracy of the body surface area measurement, it's worth discussing this with your surgeon and insurance representative.
Your surgeon may be able to provide additional documentation or justification to support your case for coverage based on your unique body composition. Ultimately, the goal is to ensure that you receive the care you need while navigating the requirements of your insurance plan.
By advocating for yourself and working collaboratively with your healthcare team, you can hopefully find a solution that meets both your medical needs and insurance requirements. Good luck with your journey towards a breast reduction procedure!

Connie Hiers, MD, FACS · Answer

If you are over ideal weight for your height, the amount of breast tissue that must be removed increases. Insurance companies do not care if you have more muscle or fat. It is based on weight.

Camille Cash, MD · Answer

In order to have the procedure covered by insurance you will need to visit with a plastic surgeon for an evaluation.  Your surgeon will discuss your history including issues you've had due to the size of your breasts.  The surgeon will collect needed data and submit it to the insurance company for consideration. You will not need to calculate it yourself.

Mats Hagstrom, MD (license on probation) · Answer

I’ve requested insurance authorization for breast reduction surgery many many times.
Never have I had an insurance company request an estimate of the persons body surface.
Generally when insurance companies are looking for is that surgery is the only option to manage the two diagnoses that are used to cover breast reduction surgery, which are neck and back pain or skin rashes.
After that, they typically want to know the estimated number of grams the surgeon is planning on removing.
Sometimes the weight removed is a set number and sometimes it’s based on the patient of weight or BMI.
To make this simple for you, I suggest you first find a plastic surgeon, willing to do the procedure based on medical insurance reimbursement that you feel comfortable with and then have that provider request authorization.
Best,
Mats Hagstrom, MD

Body Surface Area calculation

Answers (4)

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