Do I Need to Lose Weight in Order For my Insurance to Cover My Surgery?

I am 5'3 and weigh 166lbs, my bra size is 34DDD/G. Do i need to lose weight in order for my insurance to cover my surgery. I have 5 different doctor referrals, i have a small frame but a large butt.

Doctor Answers 5

Breast Reduction and Weight Concerns?

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Thank you for the question.

Unfortunately, without direct examination and communication with your health insurance company, it is not possible to give you precise advice.

However, generally speaking, it is best for patients to achieve a long-term stable weight ( regardless of health insurance considerations) prior to undergoing breast reduction surgery.  Achieving this long-term stable weight will help minimize complications associated with the procedure and help decrease chances that further surgery will will be necessary ( in the future, if the patient continues to lose weight postoperatively).

 Best wishes.

Weight and Height determines amount required for Breast Reduction

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Breast reduction is covered by insurance companies based on 2 factors.  First, you must have symptoms related to the large breasts such as neck, back and shoulder pain or rashes.  Second, you must have the amount removed that meets their criteria.  Their criteria is based on body surface area, which is determined by your height and weight.  Losing weight will not help you qualify.  I recommend you consider a new technique called The Ultimate Breast Reduction.  This technique relieves breast pain by transferring the weight of the breast to the underlying muscle.  This is done without unattractive vertical scars such as lollipo or boat anchor shaped incisions.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Breast reduction?

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An exam in person would better determine if you were a good candidate for a breast reduction. I will say that insurance companies have gotten tougher and tougher about coverage for this procedure.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Weight requirements for breast reduction

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Many insurance companies use a body mass index calculator to determine whether a patient is eligible to have a breast reduction on the presumption that, if you were to lose weight, you wouldn't need the operation.  I know that this may not sound logical to you, but it is a way of denying coverage.  Other factors such as conservative medical management and documentation of treatment are relevant as well.  You should be able to see your insurance criteria online.  See  a board certified plastic surgeon in your area who is familiar with the criteria and can offer you guidance.

Insurance coverage for breast reduction surgery

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Dear Meela.  All insurance plans are different.  With your height and weight, you are considered borderline between being "overweight" and "obese".  Check with your insurance company's policies regarding breast reduction.  Often times this information is found online on their website.  If you can't find the information, then call them and ask to speak with a representative.

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.