Currently a 38N(38JJ UK size) but very overweight, how likely is a breast reduction to be approved by insurance?

Question

I am 5'3 259 pounds(37 inch waist, 56 inch bust) with a bra size 38N. I cannot afford to pay for a surgery on my own, I was wondering how likely it is to be approved by insurance for the surgery? I have had medication, physical therapy, special bras etc. I have shoulder indents, bruises on my ribcage and shoulders alone with extreme back and neck pain. I am just worried that my weight is too high(I am working on that at the gym). I have been recommended by several doctors for this surgery.

Tommaso Addona, MD · Answer

Thank you for your question.
With a breast volume of that size, I could see a high possibility of insurance covering your procedure. In order to do this, you would be required to receive letters of medical necessity. These are letters written by your doctors that document your symptoms and would recommend a breast reduction as the best form of treatment. Since you have tried alternative method of treatments including weight loss as you are working at the gym, it is my recommendation to receive these letters.

Ronald J. Edelson, MD · Answer

Each insurance company is different regarding their requirements. However they often try to avoid coverage when they can. In your case they may tell you to lose weight. You should call your insurance company to find out the steps you need to take, unfortunately  it’s often an uphill battle

Daniel Barrett, MD · Answer

Dear Peaceful287219,
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

Camille Cash, MD · Answer

The answer to this is not a straightforward yes or no.  Your insurance carrier may require a certain BMI to qualify for insurance.  Your health history will need to be considered as well.  Having a high BMI can increase your risk of complications from surgery such as infection and poor wound healing. You can begin by visiting with a board certified plastic surgeon near you and in the meantime continue your efforts to lose weight.

Douglas Taranow, DO, FACOS · Answer

Photos would help to answer your question. 
Your BMI is way too high to consider a cosmetic procedure.  Weight loss is essential

Darryl J. Blinski, MD · Answer

Most likely you WILL NOT be approved primarily based upon your height & weight or BMI. Your BMI is 45.87!!! very overweight. Most health insurances eliminate you based upon such a very high BMI, usually written in your insurance plan/contract you signed. First must lose weight, about 50+ pounds to be considered for any insurance coverage.

Jose A. Munoz, MD - Account Suspended · Answer

Hi and welcome to our forum!Your candidacy for surgery requires consideration of many factors. One is measurement of your BMI (body mass index equals weight in kg / square of height in meters). You can find BMI calculators on the internet. If your BMI is greater than 30, the cosmetic result will not be optimal. If your BMI is greater than 35, your operative risk will rise. Your BMI is 45.87. Weight loss through diet and exercise is recommended before surgery to reduce your operative risk. If not achievable, a bariatric procedure (such as a gastric sleeve) will result in significant weight loss. It is now performed on an out-patient basis. From the surgical standpoint, you presently appear to have symptoms attributable to your breasts. Under these circumstances, you would benefit from breast reduction. It is best and safest to have a BMI of less than 35. From the insurance standpoint, different companies have different criteria. Some will require a surgical specimen to be of a certain weight, most will accept symptoms, some require a course of preoperative physical therapy. Most will consider your BMI. I recommend a consultation with a bariatric surgeon and perhaps aboard-certified plastic surgeon. Best wishes...

Currently a 38N(38JJ UK size) but very overweight, how likely is a breast reduction to be approved by insurance?

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