Can I get a breast reduction?

I am a size 36i in bras and weigh 195. My breast hurt really bad and it's sore. I have dark scares and broken skin from bras and indented shoulders. I've been on a diet it loose weight but when I was 135 I had a size 34ddd bra. I don't think losing weight will fix this. Can I get approved for a breast reduction as a medical need?

Doctor Answers 9

Can I get a breast reduction?

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With what you describe it seems you definitely can benefit from a breast reduction.  However, in terms of getting approved by your insurance, it all depends on the insurance policy you have.  Your plastic surgeon's office can help you find out what your insurance's guidelines are for approving a breast reduction.  In most cases, in addition to the symptoms you describe, insurance companies require documentation of your symptoms for a 3-6 month period and unresponsive to conservative management.

Breast reduction candidate, some advices:

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Thanks for the question. 
I recommend you to send your photos to us to give you the advices you want.
Kind regards,
Dr. Emmanuel Mallol.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 307 reviews

Breast Reduction and Insurance Coverage

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The answer from your description for the moment is "most likely". 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.

Breast reduction - am I a candidate?

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Thank you for your question about your breast reduction.

  • It sounds as though you are a candidate for a breast reduction -
  • go to your health insurance website and find the plastic surgeons on your insurance panel.
  • Schedule and appointment.
  • Your surgeon will submit a letter to the insurer, asking for approval of your surgery.
Always consult a Board Certified Plastic Surgeon.
Best wishes. Elizabeth Morgan MD PHD FACS

Breast reduction and insurance

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You need to check with your insurance company to see what their criteria are for approval. Best of luck.

Who's a breast reduction candidate?

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As with any plastic surgery procedure, it would be important to make an assessment after you were seen and evaluated by a board certified plastic surgeon.  Your overall health, smoking/nicotine status, family history, age, weight and many other factors would need to be evaluated and depending on that, your examination and your symptoms, you would be a candidate or not.  In general , if you have large breasts that limit your lifestyle and you are healthy, you are a good candidate.  It sounds like you would benefit from the procedure which a board certified plastic surgeon can explain best face to face.   It would definitely be worth getting a consultation.  Good Luck!

Have a check

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You likely will meet the criteria for most medical plans.
Visit a board certified plastic surgeon for and examination and pre-approval.

Can I get a breast reduction?

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Thank you for the question. Based on your description, you may be an excellent candidate for breast reduction surgery. This operation tends to be one of the most patient pleasing operations we perform.
“Typical” patients who present for breast reduction surgery are women who have disproportionately large breasts, causing problems such as neck/back/shoulder discomfort, postural changes, bra strap grooving, skin irritation/rashes under the breasts, and/or difficulty with activities of daily living and/or exercise etc. There may be both physical as well as psychosocial “stress” caused by the disproportionately large breasts.
Reducing breast tissue mass and elevating the breasts on the chest wall tend to improve or alleviate many of the symptoms associated with the disproportionately large breasts.
Patients considering breast reduction surgery should also consider the potential downsides (risks/complications) associated with the procedure as well. Poor scarring, for example may be associated with the procedure. Additional surgery may be necessary in the short or longer term for a multitude of reasons.
When the time is right, I suggest that you seek consultation with well experienced plastic surgeons who can demonstrate significant experience achieving the types of outcomes you would be pleased with. Ultimately, careful selection of your plastic surgeon will be the most important decision you make.
To this end, 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.
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.

I hope this, and the attached link/video, helps. 

Breast reduction and insurance approval

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There is no secret sauce that a plastic surgeon has that tells us who will or won't be approved for an insurance reduction.  Based upon years of experience, many of can predict coverage with a high degree of accuracy in many cases but the only means to tell for certain is to submit the information to the insurance company.  
The criteria that seem to be used to decide if it's covered include:
Patient height and weight
Breast size
Breast photos
Breast measurements
Medical history
History of neck or back problems
History of treatments that have failed for neck and back problems
The amount of tissue, in grams, that the surgeon thinks will be removed

please consult a board certified plastic surgeon for your specific case

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.