Breast Reduction? (Photos)
Doctor Answers 14
Breast reduction and insurance
At times insurance companies will pay for Breast reduction. Each plan has its own specific criteria for medical necessity. Usually long term symptoms and failed conservative therapy documented by the appropriate specialists. Estimates of breast tissue resection is also required with photos and letters of medical necessity.
Insurance coverage for breast reduction
Typically insurance companies deem breast reduction surgery medically necessary (and covered) if you have certain musculoskeletal symptoms (such as back, neck, shoulder pain) and/or hygiene problems (rashes under the breasts). They typically also require that a minimum amount of breast tissue be removed at surgery. Nowadays, most companies use some sort of sliding scale to determine what that amount is. One such scale in common use is the Schnur Scale which bases the amount of tissue to be removed on body surface area (BSA). In your case, you have a BSA of 1.78; and you would be required to have about 420 gms of tissue removed from each breast. If only the minimum were removed, I would estimate from your photos that this would leave you at about a small C cup. So, if you really want an A cup, you should have no problem meeting the insurance requirements.
The only way to find out for sure whether the procedure would be covered is the submit a pre-authorization request to your insurance company. This would be done by your Plastic Surgeon. So, your next step is a consultation with an experienced, board-certified Plastic Surgeon to discuss you particular situation. Best of luck in your quest for the best breast for you.
From looking at your pictures you look like a good candidate for a breast reduction. It is possible that your insurance will pay for it if your breasts have caused you to have back and neck pain, but you will have to check with your provider about their policy. Your next step should be to consult in person with a board certified plastic surgeon so that he/she can examine you in person and together you can determine the exact size you want your breasts to be following surgery. Good luck!
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You are an excellent candidate for a breast reduction surgery. Please visit a few ABPS certified/ASAPS member surgeons that specialize in cosmetic breast surgery.
Best of luck!
Pain Relief from Breast Reduction Surgery
You are a good candidate for breast reduction surgery. I enjoy doing this surgery because patients are always so happy with their results in both how they look and how they feel. Right after surgery, you will feel the relief you feel when you hold your breasts up. However, you do not need to get down to an A cup to relieve your pain. A small B cup will achieve the same. And, if fact, your surgeon might not be able to get you to an A cup since breast tissue with a blood supply needs to be maintained underneath your nipple areas.
You will need to check with your insurance company to see what their requirements are. Most insurance companies use the Schnur Sliding Scale to determine the minimum amount of breast tissue that needs to be removed from each breast in order to qualify. Your Body Surface Area (BSA) is calculated with your height and weight. Your BSA is 1.82 m2. Using this scale, you would need to have approximately 450 grams of tissue removed from each breast. Consult with a board certified plastic surgeon who does breast reduction surgeries and who is a provider in your insurance plan.
Thank you for your question and photos. You appear to be an ideal candidate for breast reduction. The discomfort that you feel in your back and likely neck and shoulders can be improved with a breast reduction. With adequate documentation from your primary care physician, insurance may cover this if it is perceived as medically necessary. This is a favorite surgery of mine as women can feel the difference as soon as they wake up and it makes life easier and less painful having breasts that are more proportionate for their body.
Consult with a Board Certified Plastic Surgeon in your area. They can check with your insurance company to see if it is a covered benefit.
Hello, looking at your pictures you have the appearance of patient's who seek breast reduction surgery in order to relieve neck, shoulder and back pain as well as to restore proportion to the size of their breasts with the remainder of their body. Surgery will not only reduce the size and weight of your breasts, but also raise the position of your breasts and narrow your breasts. There are a number of different techniques which individual surgeons use to achieve this result and it is important that you seek out a surgeon who will most closely achieve your desired goals. You will have to accept some scars, possible change in your nipple/areolar sensation and likely impact your ability to breast feed. This needs to be discussed with your operating surgeon. Given your height and stated weight, it is my opinion that an A size cup is unrealistic as it would be disproportionate the rest of your frame. Again, at your surgical consultation have a clear discussion with your surgeon so that your goals are achieved. Always consult a board certified plastic surgeon with an expertise in breast reduction to obtain a definite surgical plan.
Insurance coverage for breast reduction
There are hurdles but insurance may cover your surgery. It is a process and can take six months from consultation to surgery. You do need to have realistic expectations in terms of sizing; an A cup may leave you pear shaped. Generally, you will be required to demonstrate that conservative management in the form of physical therapy or chiropractic over three months has been unavailing.
Breast reduction, some advices:
Thank you very much for sharing your concerns with us.
After having analyzed all the information provided to us, i can realize that you have very large breasts for your height and weight, and can be responsible for head, back, neck and shoulder pain.
In the future may cause permanent osteo-articular damage in the back and shoulders and skin problems (mainly under the breasts). For for this reasons, certainly you need a breast reduction surgery.
Insurance questions are best addressed with your insurance company. I recommend you seek an in person exam/consultation by an experienced Board Certified PS
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.