Is weight loss required before breast reduction in order for insurance coverage?

Question

I am 5'1" tall and weigh about 190 lbs. I know this is considered obese and have tried losing weight but it is physically painful for me to exercise. I have had several yeast type infections under my breasts which has resulted in days missed from work. I have back pain that I treat at home so it hasn't really been documented. I really don't want to end up like my grandmother, who at 4'10" and not a heavy woman, wore a 44G bra. Is it likely that insurance would cover a reduction?

Richard A. Bartlett, MD · Answer

Dear conosomom, Thank you for your questions. You do not necessarily have to lose weight prior to surgery, but if you plan to your surgeon would probably request that you do so before scheduling since that would affect the approval by the insurance. I would have a consult with a board certified plastic surgeon, and contact your insurance company to find out what their criteria is. Your surgeon will likely prescribe you an antifungal powder for use before surgery (usually 2 weeks before) but it may be beneficial to start this immediately to prevent those irritations from occuring. I hope this helps! Good luck!

Shwetambara Parakh, MD · Answer

Your body mass index is 36, having said that weight loss is not an absolute criteria, Size of the breasts in relation with the size of your body is more important. Seek  in person consultation with board certified plastic surgeons in your area to determine your eligibility. You may also call your insurance company to see what their criteria are. If you get an infection in your breast fold make sure you see your primary care doctor for documentation and medication. This information would also be helpful in getting insurance coverage for your breast reduction surgery. Good luck !

Edwin Chang, MD · Answer

Most insurance companies I come across do not have any weight requirement.  Though, there is a large insurance company in the area that will not approve breast reduction for patients over 150% "ideal body weight."  For patients who are considering losing a significant amount of weight, I typically recommend that the weight loss be achieved before, rather then after the surgery.  Significant weight loss after the surgery can cause the cosmetic outcome to degrade.

Steven Wallach, MD · Answer

You have to check with your insurance company to see what their criteria are for approval. Best of luck.

Is weight loss required before breast reduction in order for insurance coverage?

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