I need a breast reduction but I can't afford it. It is taking a huge toll on my everyday life.

Question

Ever since I was 10 years old, Ive had large breasts (around a c). since then (Im 20 now) they have continued to grow. I am now a 36 E and can barely do every day things like working, walking my dog etc without gasping for air, having awful shoulder and back pains to the point of tears. I went to a dr. and he said i needed it but insurance won't cover it. I don't know what to do. Im looking for a doctor who has the compassion to help me. I will be forever grateful.

Larry S. Nichter, MD, MS, FACS · Answer

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation 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. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive.

Richard J. Wassermann, MD, MPH, FACS · Answer

Hello and thank you for reaching out. It does sound like from the symptoms you have described that you would benefit greatly from a reduction surgery. Every insurance company is different and has many different requirements that must be met before they will authorize a breast reduction surgery. Many factors play out such as a patient's BMI, medical conditions, etc and can be very confusing and frusterating to a patient if the surgery is denied. Perhaps consult with another board certified plastic surgeon for a second opinion and reach out to your insurance company for their requirements. Best Wishes.

M. Bradley Calobrace, MD, FACS · Answer

Hello. That must be very frustrating. Try calling your insurance company and finding a provider who performs breast reductions and who also takes your insurance. If you are an E cup, insurance should cover it. Insurance companies base the need of a breast reduction on how large your breasts are. The bigger the breasts, the more grams they can remove to improve your quality of living. They key is finding a qualified provider in-network and setting up a consult. Hope this helps.

Sherwood Baxt, MD (retired) · Answer

Look for a BCPS  in your area that specializes in the liposuction only reduction. It may be very affordable even without the insurance. Quick, simple, safer, outpatient procedure and your back functioning in days. Not ideal  and not for everyone but something to consider.

I need a breast reduction but I can't afford it. It is taking a huge toll on my everyday life.

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