34DD with 450 gram reduction?

Thank you for your question. Since your breasts are highly dense, removing 450 grams per breast might take you closer to a B cup, as your surgeon mentioned. If you feel that the 450-gram requirement will leave you too small, another option would be to pay for the surgery out of pocket without involving insurance. This would give you more flexibility in terms of how much breast tissue is removed, allowing you to achieve your desired size while still addressing your pain. If you proceed with the insurance-covered reduction and later feel your breasts are smaller than desired, fat transfer can be an option to add subtle volume back, though this would require a separate procedure. Your surgeon should work with you to balance back pain relief and maintain a comfortable size. Let your surgeon know you’d prefer to end up closer to a C cup rather than a B or smaller one.

If insurance is saying they require to remove 450 grams then you will most likely end up a size A. At size 34, each 100 grams remove corresponds to 1 cup size change. You will go down 4 1/2 cup sizes. I recommend you do not do this. The technique I recommend is The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your 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. Unfortunately, this technique is not covered by insurance.

Best Wishes,

Gary Horndeski, M.D.

If you are concerned about size then you may wish to consider paying out of pocket for the procedure. This way your surgeon can tailor the results to be in line with what you are wanting versus the requirements of the insurance company. If you are unsure about what a "B" cup means, which is understandable since cup sizes are inconsistent, you may want to further discuss with your surgeon what you can expect in terms of results.

If you want insurance to cover the surgery, then your surgeon will need to remove 450 grams. Usually, most companies want more. If you later decide that your new size is too small, a fat transfer can be done or an implant. You actually may love your new size and are happy to be free of the excess weight. also, your surgeon must keep enough breast tissue behind the nipple to keep it alive. An A cup is too risky.

Breast cup size tends to be somewhat subjective.
I suggest you ask surgeons to show you before and after pictures of previous patients who had similar breast characteristics to your own.
You can ask the surgeon to look up how much tissue was removed during each case so you have a better understanding of What removing Tissue is likely to deliver.
Typically normal breast reduction reduces breast tissue by about 50%.
This obviously varies depending on the patients need.
You should recognize that insurance reimbursement to the surgeon is only going to be a tiny fraction of what most plastic surgeons charge when this is a cosmetic procedure.
The difference in financial income going through insurance vs self pay is quite dramatic on behalf of the surgeon. That said it’s even more so for the patient what has to pay for all cost including anesthesia, OR and lab fees if not authorized by insurance. If authorized by insurance, the surgeon is not allowed to charge the difference.
Many plastic surgeons do not accept medical insurance.
The ones that do should serve as a patient advocate, not steering people towards pay cash when it’s a covered insurance benefit.
Get second opinion consultations.
Considers consulting with plastic surgeons who do a lot of insurance based surgery like those who do most of the breast cancer reconstruction in your community.
Plastic surgeons who do a lot of breast cancer reconstruction tend to be really good at all aspects of breast surgery, including breast reduction.
If you’re having symptoms, then you should be able to have a breast reduction and still have sufficient breast tissue to feel good about yourself.
If anything most patience, wish they could be smaller afterwards.
A reduction does leave the breast somewhat flat without good projection.
This should be a covered benefit for you.
What should be covered by insurance becomes a very expensive self-pay procedure.
Best,
Mats Hagstrom MD