Do I qualify for a free or a low cost breast reduction?

Question

I am 17, 235 lbs, 5'5 and I wear a 38 JJ. I have constant discomfort, from neck, shoulder, and back pain, as well as bruises from the grooves that my bra's cause in my shoulders. Big breast run in my family and I believe that my breast are also the cause for my weight problems because my breast are very unproportioned to my body.

John D. Smoot, MD · Answer

Thank you for your question and you probably will need a reduction at some point but without photos it is difficult to answer your question directly.  You need to consider several items which could affect your decision to have surgery.  You have not fully matured and your breast may continue to grow and your weight may fluctuate up or down.  You will need to be psychologically ready for this surgery.  I would see a board certified plastic surgeon who can help guide you through this decision and see if your insurance will cover this procedure.

Stephen M. Davis, MD, FACS · Answer

Based on you height, weight and BMI it appears as though you would qualify, however each insurance company has it's own criteria. It is best you find a local surgeon who can help you understand how your insurance might help you.Stephen M. Davis, MD, FACSGreen Hills Plastic Surgery

Jennifer Capla, MD · Answer

Thank you for your question. Based on the dimensions that you have provided and a description of your symptoms it does sound like you may be a good candidate for a breast reduction. A photo would be helpful to determine proportions. A breast reduction is an operation that may be covered by your insurance company if you meet their criteria. I recommend that you see a board certified plastic surgeon who can determine if you are a good candidate and help you with the process. Best of luck.

Patrick L. Basile, MD · Answer

This is a tricky question because it has to do with both your anatomy AND your insurance company. A lot of insurance companies are requiring certain documentation of having medical issues secondary to macromastia (large breasts). This can include, but not be limited to chronic fungal infections, back pain, shoulder grooving, etc.. They may also want to you see you fail other non-invasive modalities like physical therapy prior to giving you approval. Finally, most insurance companies are using BMI to determine a minimal amount of resection that would be authorized. The higher the BMI, the more they expect to be removed. This proves to them that this procedure is really being used as a functional surgery more than a cosmetic surgery. Your BMI is about 39 so you would need to check with your surgeon to make sure that he/she would leave you with a cosmetically pleasing breast despite having to remove so much tissue. You did not include any pictures, but if you are really a 38 JJ then your surgeon should not have a problem resecting the minimal amount and may even take off more to help relieve your symptoms. You should find a reputable board certified plastic surgeon in your area who has experience with breast reduction surgery.

Jason M. Petrungaro, MD, FACS · Answer

Based on your description of your symptoms, your height and weight, and your breast size, it sounds like you will be a candidate for a breast reduction.  But remember, only an actual consultation with a Plastic Surgeon can determine the final answer to that question.To answer your financial question, it all depends on what type of health insurance you currently possess.  Medicaid, Medicare, and private insurance will all cover a breast reduction if your surgeon feels it is indicated and all of the proper paperwork is submitted (sometimes you will need notes from your primary care doctors, etc).  If your surgeon does not accept any of the insurance that I listed, then you will need to pay out of pocket for the surgery.  You can call the Plastic Surgeon's office and ask them what insurance they accept, and if they accept yours, make an appointment.  Best of luck!

Ronald V. DeMars, MD (Retired) · Answer

Thanks for your question, but I'm not sure what you mean. Surgery is expensive and there is no "free or low cost" surgery or the doctor and his staff woud soon be out of business. If you mean do you qualify for insurance coverage, you would need a consultation and then the doctor will communicate with your insurance company to see if you meet their requirements.

Do I qualify for a free or a low cost breast reduction?

Answers (6)

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