Will insurance cover breast reduction ?

Doctor Answers 6

Will Insurance Pay for Breast Reduction Surgery?

Thank you for your question. 

In general when the excessive breast size causes functional problems, #insurance will generally pay for #breastreduction 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. 

Breast reduction is very successful in reducing these problems. #Candidates for breast reduction surgery are women who wish to have smaller breasts to achieve a more proportional appearance or to alleviate physical discomfort. Breast reduction can correct symptoms from excessively large, heavy breasts that may cause the inability to do certain exercises, or create back, shoulder and neck #pain, poor posture, bra-strap shoulder #indentations and chafing or rashes under the breasts.

The best advise I can give you is to schedule a consultation with a Board Certified plastic surgeon who will be qualified to evaluate your current breast shape and volume. They will also be able to explain all of your options. Good luck!

Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Will insurance cover breast reduction?

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. This operation tends to be one of the most patient pleasing operations to 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. 

This 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. 

In regards to the outcome of the breast reduction surgery, the most important decision you make will be careful selection of your 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.

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 1,487 reviews

Breast reduction and insurance

You are best to check with your insurance company to see what criteria they have for approval. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Will insurance cover breast reduction?

We find in our area, Chicago, most health plans will indeed cover breast reduction though there are some exceptions. This issue can be easily settled by your surgeon with a predetermination review with your insurance plan. 

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Breast reduction

Thanks for your question. The answer is, it depends. Most insurance providers do cover breast reduction surgery if you meet certain criteria. It requires an in-person consultation with your plastic surgeon, and then they will review it. I would say 90% of the patients I see for symptoms related to large breast size do get approved. Best wishes.

Paul J. Leahy, MD
Leawood Plastic Surgeon
5.0 out of 5 stars 8 reviews

Breast reduction - will insurance pay?

Thank you for asking about your breast reduction.

  • Your is a very reasonable question but the answer is, 'it depends on your insurance.'
  • So first check with your insurer as to whether it will cover it and what criteria you need to meet to have surgery 
  • Some insurers require chiropractic treatment, massage or other treatments first
  • Then see  a plastic surgeon and have a pre-determination request sent to the insurer.
  • if the answer is 'yes, the surgery is covered that is good news but remember - you will still have to pay all deductibles ande copays before having your surgery.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 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.