Insurance denial - would it be worth it to get a second opinion?

Thanks for your question! There is no harm in getting a second opinion to see if another surgeon is comfortable removing more tissue. You may get the same outcome, but you may get a different one and it is worth the try. Good luck!

Hello, second opinions are always a good idea as they give you a chance to see how different surgeons approach things in their unique way and therefore see who may be a better match for you. Based on the measurements provided, your BMI is 37.1 and your Body Surface Area (BSA) is 1.91. Every insurance company is different and may use slightly different criteria for approval/denial. The Schnur scale is one common scale used in breast reduction surgery and it gives doctors/insurance companies the average grams of tissue per breast to be removed for a certain BSA. Based on your BSA of 1.91, you would need approximately over 530g of tissue removed per breast to qualify according on this scale.

Hi,
Thank you for the question.
It is worthwhile getting a second option to see if the breast reduction procedure gets approved.
Based on what you are describing, it does sound that you have large/heavy breasts causing physical symptoms, and breast reduction may be an option for you. However, it is difficult to tell without seeing the photos and/or in person consultation. During breast reduction surgery, excess breast tissue is removed, the breast is lifted and nipple/areola is typically made smaller. It is easiest to think of breast reduction as including the breast lift.
Schnur Sliding Scale is a scale used by many insurance companies as a guideline for how much breast tissue should be removed in order to improve your physical symptoms. In addition, most insurances in order to approve the surgery, will require for 2-3 letters of medical necessity (from your chiropractor, primary doctor, OBGYN, Dermatologist, etc) demonstrating that your physical symptoms due to large breasts are not improving with conservative management.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. I hope this helps.
Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Yes, because it your truly are a DDD, then you should be able to have 500 grams easily removed from each breast and should be covered. Go meet with someone else.

Large breasts may not only interfere with your physical ability to function in daily activities but can be emotionally burdensome as well. From what you describe you are a candidate for a breast reduction. Breast reduction surgery removes excess breast tissue and reshapes the contour of the breasts so that they are smaller and perkier. It is possible to do a breast reduction with a minimal scar technique and can also be done as an outpatient procedure under twilight sedation. It's important to be sure expectations are realistic and you have an understanding of the commitment needed for the healing process. Make sure that you understand the nature of your surgery, the recovery process, and that you feel comfortable and emotionally ready to make these changes to your body. Breast reduction is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine, which sounds like your situation. I suggest you make an appointment with another board certified plastic surgeon and get a second opinion to see what is the optimum of breast tissue to be removed during your breast reduction surgery.

From your description it sounds like you are a good candidate for a breast reduction. A second opinion may be helpful to at least hear varying opinions. If going through insurance is not an option for you, many plastic surgeons work with financing companies that specialize in medical procedures.