I'd like to know if I'm a good candidate for a breast reduction surgery (photos)

I'm 21 y/o 5'1" 105 pounds DD/D. I'm wondering if I would still be a good candidate for a breast reduction. and also if my health insurance would cover cost I have united health care -- oxford insurance. They require that the amount of tissue to be removed plots above the 22nd percentile with functional impairment to be considered reconstructive. They chart BSA of 1.40 with 139 being removed in the 5th percentile which would be considered cosmetic and 218 being in the 22nd percentile.

Doctor Answers 11

Breast Reduction

Yes, you are a great candidate for a breast reduction.  This will address any bra strap grooving, back pain, neck pain that you may have.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with and who is a board-certified Plastic Surgeon certified by the American Board of Plastic Surgery. Best wishes! Dr. Desai
Harvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

#BreastLIft #BreastReduction - good candidate for a breast reduction

There are two issues here:1) Are you a good candidate for a surgical procedure, and2) Will the insurance company pay for it?
1) Based on these photos, it looks like you would benefit from a procedure.  As you probably know, a Breast Lift and a Breast Reduction are essentially the same procedure, with the difference being the amount of tissue removed.  If you're willing to have the scars associated with these procedures, they it seems that you could have a nice result.  You don't indicate if you've had children or whether you plan to; those issues can factor into the recommended timing for a breast lift or reduction.
2) Getting an insurance company to "cover" a breast reduction is not necessarily that simple.  Although there are formulas they typically reserve the right to make that decision only after the surgery.  That can put you, and your surgeon, in a difficult position - what should be done if your surgeon feels that you have an appropriate and aesthetic result but the "required minimum" of tissue hasn't been met?  Denser breast tissue will weigh more per unit volume that fattier tissue (nothing personal) and the result is usually based on volume - but the insurance company will make a decision, instead, based on weight.
These things need to be discussed with your PS.  The safest approach is to pay for this procedure on your own and have it on an outpatient, ambulatory basis (where the costs are typically lower than in a hospital) and then get insurance reimbursement if applicable.  Either way, you should have as good an idea as possible of both what the surgical results will be, and what your financial obligations will be.
I hope that this helps and good luck,
Dr. Alan EnglerMember of #RealSelf500

Breast reduction candidate?

Breast that are too large, often give symptoms of bra strap grooving, back/neck pain and rashes under the folds, to name a few of the most common. Judging from your photo , your breast appear to be too large for your frame and if you have the other symptoms you may be able to have a breast reduction covered by insurance. You did your homework and already know some of the insurance company requirements such as the amount of breast tissue estimated to be removed that will qualify. Next step is to see a board certified plastic surgeon who is comfortable with breast surgery to examine you and discuss the procedure in detail.

Sheila Bond, MD
Montclair Plastic Surgeon
4.5 out of 5 stars 38 reviews

Breast reduction

Best to come in for consultation to be properly evaluated so that an adequate exam can be performed and a review of your goals can take place.  I will often do limited incision lollipop type skin excision patterns to minimize scarring. Sometimes  a "T" incision is necessary instead. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Breast reduction candidate

Thank you for your question and posting pictures. You seem to be a good breast reduction candidate. Does a look like you've done your research which is excellent. You would need to have a consultation for precise recommendations and our offices will speak with your insurance company to obtain coverage if deemed medically necessary. 

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.8 out of 5 stars 88 reviews

Dr Kayser

Thank you for your question. It is difficult to determine whether or not your insurance would cover the procedure. As noted below, insurance companies  are making it more difficult to have the coverage. Medical necessity is also essential. Finally, based on co-pays and deductibles, it often turns out to be less expensive to have the procedure scheduled as cosmetic rather than Medical. Also, be aware that there are many techniques available with regard to breast lift reduction surgery. The more traditional techniques involving upside down t or anchor approach, however, there are newer short scar lollipop type methods which can improve shape and reduce scarring. In any case, I would recommend a consultation with a board-certified plastic surgeon who is experienced in these various techniques. I hope this helps and have a wonderful day Dr Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 31 reviews

Reduction

You look like a good candidate, but I doubt your insurance will actually pay. They say they will but then find some excuse not to pay. Best have it done as an out patient and pay yourself. 

William B. Rosenblatt, MD
New York Plastic Surgeon
4.1 out of 5 stars 11 reviews

Breast reduction

Oxford rarely covers patients with 200 gram resection per breast.  Insurers are making it more difficult daily and anything at the 500 gram level is becoming suspect. You do not have the shoulder grooving associated with symptomatic macromastia. There are other criteria which must be fulfilled as well.  You could benefit from a mastopexy or small reduction but I would expect it to be on a fee for service basis.

Yes

Based on your photos and story, I think you'd be great for a reduction mammoplasty. This would give you a smaller size and, more importantly, a pretty shape. You could have the fullness in the 'right' places in the breast and the results would be great. Be sure to choose a boarded surgeon that you are comfortable with. I think it's also best to have someone with at least 10-15 years of experience. Best of luck.
Leland Deane, MD FACSNew York, NYGarden City, NY

Leland Deane, MD
Long Island Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast reduction candidate

Hi there,
Unfortunately I can't comment on your insurance question as I am from Australia, but from a clinical perspective you are an excellent candidate for a reduction.
For what it is worth, I think you would get a significant improvement from a functional point of view as well as an aesthetic perspective.
A breast reduction essentially involves three components:
1. A reduction in breast tissue in both weight and volume2. A breast lift. Your nipple will be lifted to a more attractive position relative to your fold3. Tightening of the skin envelope. Obviously once the breast tissue has been reduced and the nipple lifted, there will be redundant skin that needs to be tightened.
Breast reduction patients are usually amongst the most satisfied patients in a plastic surgeon's practice, and it always rates highly on "worth it" scales.
Next step for you is finding a plastic surgeon you feel comfortable with. They will go over the specifics of the operation and should be able to answer your insurance questions.
Best wishes
Richard

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.