I'm 26 yrs old. My Insurance Didn't Approve Me for a BR, but They Did Approve Me for the Bilateral Mastopexy. Will This Help Me?

I am 26, 5 feet 2 inches and I weigh 168. Im currently wearing a 40 DDD ( im pretty sure I should ne wearing a bigger size), and I do suffer from ptosis, back and shoulder pain. Since my insurance has a exclusion for the breast reduction surgery and denied me, my doctor submitted one for the mastopexy. They approved me for that procedure, however, Im not sure how much this will help me. Whay should I do?

Doctor Answers 10

Breast lift may not be sufficient

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It is unusual for a breast lift to be covered by insurance. Regardless, the procedure may not help you as much because your breasts will still be quite large. While mastopexy can reduce breast size, it is usually not significant enough that it will have a measurable impact on the pain caused by your large breasts.

My Insurance Didnt Approve Me for a Breast Reduction, but They Did Approve Me for the Bilateral Mastopexy. Will This Help Me?

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Insurance will cover some breast reductions, but I am not sure that they will cover breast lifts. Find a plastic surgeon with ELITE credentials who performs hundreds of breast lifts each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

Breast lift vs reduction

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In my experience, insurance companies generally do not approve mastopexies but do cover breast reductions.  A breast uplift is generally considered a cosmetic procedure while a reduction is considered medically necessary.  That being said, a lift alone will probably not alleviate your symptoms.  Best of luck.

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Insurance coverage

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It is extremely rare and unlikely your insurance company approved a breast lift which is considered cosmetic.  I'm guessing that they may have approved your reduction.  Call your carrier for clarification.

Insurance coverage for a breast lift.

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I would suggest you call your insurance company to verify the approval.  Insurance companies have been known to give "approval" only to deny later when a procedure is determined to be cosmetic.  

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 189 reviews

Never heard of an insurance company approving a mastopexy

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Most insurance companies will not cover a procedure that is cosmetic.  The two surgical procedures are similar except that the breast reduction removes breast tissue and the breast lift only removes skin.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Mastopexy vs breast reduction

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I have never heard of an insurance company approving a breast lift procedure because this is considered cosmetic.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Mastopexy vs Breast Reduction

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Mastopexy is always considered cosmetic surgery in my experience. But, a breast reduction is just a mastopexy with some escess tissue removed, a mastopexy is a reduction of breast skin, but not glandular tissue. they are about the same but vary in what tissue is excised. If your surgeon is getting paid, he proably won't care what you call the procedure.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Mastopexy vs Breast Reduction

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This scenario sounds a little odd.  I have never had any insurance company approve a mastopexy.  They do approve breast reductions when certain criteria are met.  You do sound like a candidate for approval for reduction.  Please confirm it is a mastopexy that you were approved for and not another procedure, such as mastectomy.  All the Best. 

Steven Svehlak, MD
Los Angeles Plastic Surgeon
4.6 out of 5 stars 32 reviews

Insurance and Breast Surgery

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I have never heard of an insurance company approving a Mastopexy.  Clarify this with your Plastic Surgeon prior to surgery.  Best wishes!

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 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.