How many grams typically are removed going from a 40h bra size to DD?

Question

I am currently 240 lbs. and 5'8". I am a 40H in bra size. I am trying to obtain a breast reduction and have it paid through my insurance. I have looked at the scale and my BSA is 2.30...the 22nd percentile says removal of 1068 per breast...would that be too much. How much weight would I need to lose?

Gary M. Horndeski, MD · Answer

Thank you for you question, The Horndeski Method/The Bellesoma Method is a current technique to lift and/or reduce breasts without using implants or the ugly vertical scars.  The incisions are hidden around the areola and in the inframammary crease. The vertical incision has been completely eliminated. The areola incision heals almost invisibly due to the fact that there is hardly any tension on the closure. With this particular technique, ducts are preserved along with nerve supply maintaining nipple sensation and the ability to breast feed. Because the breast is reshaped internally and is secured to your chest muscles, upper pole fullness is possible without an implant. Attached is a patient who underwent The Horndeski Method/The Bellesoma Method. Please note that her tissue was used to create upper pole fullness and cleavage without any foreign materials (mesh, implants, etc).  Unfortunately, we do not accept insurance for breast reductions.  Dr. Horndeski does not remove enough breast tissue to meet insurance criteria.  Instead, he utilizes the breast tissue to reshape the breast.  It is a proprietary technique that only surgeons that have been trained by me can perform. I hope this helps. Best wishes and kind regards, Dr. Gary Horndeski

James D. Frost, MD · Answer

Your calculations are accurate for most Blue Cross and Blue Shield of Florida plans.  Although it is difficult to know what size an H cup size really means, there is a good chance that removal of 1068 grams per breast would be feasible.  It is not possible to tell you that you would be a DD cup size afterward but you should expect relief of your symptoms.
If is always a good idea to lose weight before a major surgery like this.  Start with a goal of 200 lbs. and then if it goes well, you could consider more to be at your healthy weight.  Of course your BSA will change with weight loss so the amount of breast to remove would also change.
Good luck.

Larry S. Nichter, MD, MS, FACS · Answer

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
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Tom J. Pousti, MD · Answer

Thank you for the question.
There is no direct correlation between the amount of tissue removed and the ultimate cup size that a patient will wear after breast reduction surgery.  There is simply too much variability among bra cup manufactures to make it a useful metric when it comes to preoperative communication and/or post operative predictions.
 In my practice, I would ask that you be as close as possible to your long-term stable weight prior to proceeding with elective breast surgery. Achieving this way will improve safety of the operation and decrease chances that additional surgery will be necessary down the line.
Before undergoing the breast reduction procedure it will be very important to communicate your size goals with your surgeon (who you should choose very carefully). Most patients wish to achieve enough of a reduction to help with their symptoms while remaining proportionate with the remainder of their torso. 
With the goal of improving communication with my patients I find the use of photographs of “goal” pictures (and breasts that are too big or too small) very helpful. For example, I have found that the use of words such as  "proportionate” or "DD cup” means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. 
Once you have communicated your goals carefully, your plastic surgeon will be able to provide you with an estimation of how much tissue will need to be removed, in order to achieve your desired outcome.
Best wishes with your breast reduction procedure; hopefully you will be very pleased with the outcome of the procedure performed.

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. Unfortunately, dealing with insurance companies is often a challenging task. Your best option to see if your procedure is covered, is to contact your insurer to get details about coverage and requirements before approval for surgery (as you are doing). Given the difficulties of dealing with insurance, you can consider paying out of pocket for the surgery. For our patients, the out-of-pocket expenses for an insurance plan often approximate (or even exceed) the cost for the procedure. You can then obtain documentation from your surgeon to attempt to get reimbursement from your insurer. Any treatment plan should be based on a detailed discussion with equal input from both you and your surgeon.   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.   Preoperative visualization and surgical simulation with the Crisalix system may help with your decision. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon.  Good luck! 
  
Best,
  
Jon Ver Halen, MD FACS 
  
Harvard educated plastic surgeon

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