Will SoonerCare cover breast reduction surgery for a 15 1/2 yr old that is 5'3", 135 lbs and a 32G?

Question

My daughter will be 16 this year. She is 5'3", weighs 135 lbs, and is a 32G breast size. Her back, neck, and shoulders constantly hurt, and she cannot stand longer than 20-25 min at a time before she has to sit down to relieve the constant pressure she feels. My question is, she is on SoonerCare, so would she be a likely candidate for breast reduction surgery? Also, what are the steps I need to take to begin the process of seeing if she qualifies?

Scott C. Lindsay, DO · Answer

Hello and thank you for question.
 First, contact your Insurance carrier to find out what the requirements are to have a breast reduction covered.
Second, schedule a consultation with a board certified plastic surgeon to discuss your options.  Best wishes!

Irena Karanetz, MD · Answer

Hi, Thank you for the question. 
Based on what you are describing, it does sound that your daughter has large/heavy breasts and breast reduction may be an option for her. However, it is difficult to tell without seeing the photos and/or in person consultation. Also, it is typically recommended to wait till 17-18 years of age to ensure that the breasts have stopped growing/enlarging.
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 the 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 KaranetzFellowship-TrainedBoard Certified Plastic Surgeon

Gary M. Horndeski, MD · Answer

At size 32, each 100 grams of fat removed corresponds to 1 cup size change.  Insurance companies usually require a minimum of 500 grams removed from each breast to be approved.  If they require 500 gram removal from each breast will take her down to size C.  This will result in half of the breast tissue being removed and may result in nerve injury and the inability to breast feed.  An alternative to consider is The Bellesoma Method.  This will reduce and reshape the breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase the cleavage.  The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.  This technique is not covered by insurance companies and the cost is $12,000.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Queen_B84,
it is better to wait until breasts fully stop growing and then consider breast reduction. Breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Will SoonerCare cover breast reduction surgery for a 15 1/2 yr old that is 5'3", 135 lbs and a 32G?

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Will SoonerCare cover breast reduction surgery for a 15 1/2 yr old that is 5'3", 135 lbs and a 32G?

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Answer: Breast reduction

Answer: Breast reduction

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Everything you need to know about Breast Reduction

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