I am a 23 year old female, i am 5'4 and weigh about 133 pounds. Would Insurance Cover My Breast Reduction?

I am a 23 year old female, i am 5'4 and weigh about 133 pounds.Before i got pregnant my breast size was a 34c. Then once i had my child and started breast feeding my breast grew to a very heavy 34DD. Even after i was done breast feeding and losing all my "baby weight" i still have 34DD breasts! And to top it off my left breast is significantly large than the right one! I have developed a horibble hunch back and have constant neck and shoulder pain.

Doctor Answers 12

Will insurance cover your breast reduction?

Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Please check your insurance policy to see whether breast reduction is a covered procedure. Often times, insurance company will dictate how much breast tissue to be removed. Please visit an experiences, board-certified plastic surgeon to learn about the procedure, its cons and pros, benefits, and alternatives. Please contact your insurance carrier to learn about inclusion and exclusion criteria. Best wishes.

Houston Plastic Surgeon
4.7 out of 5 stars 76 reviews

Breast reduction insurance coverage

If your breasts are causing you pain then insurance may be able to cover your surgery. You should consult with a board certified PS to find out first if the procedure is suitable for you. If it is, they can then help you get insurance coverage. The process to obtain coverage takes a few weeks, depending on how fast your provider gives you a response.

Michael Constantin Gartner, DO
Paramus Plastic Surgeon
4.7 out of 5 stars 140 reviews

Breast reduction insurance coverage

Most medical insurance policies cover breast reductions, but they typically require that a certain weight of tissue be removed from each side to qualify.  In many cases the insurance may only cover a portion of the costs.  You should consult with a plastic surgeon who is an expert in breast surgery to understand your options.

David Stoker, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 55 reviews

Insurance coverage for breast reduction

Every insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 212 reviews

Insurance and Breast Reduction

Based on your measurements you seem to need a breast reduction. Getting breast reduction covered under insurance is very difficult. In fact getting them to tell you, as the consumer, the number of grams needed to get coverage will be nearly impossible. I suspect in the end it will have to be paid out of pocket.  The insurance frequently places the restrictions without any medical substantiation. I have had many difficulties with my own patients getting coverage. The best way to get coverage is to call your insurance company...remember you are the consumer.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 35 reviews

Body surface area determines reduction coverage

You are 5'4 and weigh 133 lbs, so your body surface area is 1.64 meters squared.  If your insurance in with Aetna, they will require 495 grams removal.  At size 34, each 100 cc's is 1 cup size change.  You will have to go down 5 cup sizes to meet criteria that would end up a size A.  It is most likely that your insurance company will not cover your breast reduction since you are only a 34 DD.  They really do not care if you have neck, back or shoulder pain or are asymmetrical.  You will NEVER meet their criteria.  Your alternative is to pay cash for the procedure yourself.

Best of Luck,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 224 reviews

Breast reduction

Photos would help,a lot in evaluating your case. Insurance companies have certain criteria for covering breast reduction surgery, including symptoms as back, neck and shoulder pain.  They almost always require a certain amount of breast tissue be removed from each breast, usually around 400 grams, or about a pound from each breast.  You need to go through the pre-authorization process. this involves a consult with a plastic surgeon who will send a letter and photos to your insurance company.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast Reduction Candidate?

Thank you for the question. Based on your description, you may be an excellent candidate for breast reduction surgery. It is one of the most patient pleasing operations we perform.

The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.

Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,501 reviews

Will Insurance cover my Breast Reduction?

I encourage you to meet with a board certified plastic surgeon who accepts your insurance and see if he believes you are a good candidate, then you will have to submit his recommendations to your insurance company and see if they agree, it can be a very difficult process to gain approval , but I encourage you to try.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 87 reviews

Insurance coverage for breast reduction

Each insurance company has it's own criteria so the first step would be for you to review these on the insurer's website. This will tell you what hoops you will have to jump through to get the procedure approved. Most insurance companies require proof that conservative medical measures did not improve your back pain, at a minimum.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

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.