Need Breast Reduction, Over BMI, What To Do?

Question

My breasts are so big that they hurt my back and I am unable to exercise. I am going to be seeing a new dr. My old dr referred me for a breast reduction surgery and the plastic surgeons at UW refused both times. They gave the excuse that I am over the BMI. What do I do?

Ronald J. Edelson, MD · Answer

You probably don't fit into the insurance company's criteria for them to pay for the surgery at your current weight. Believe me, however, if you really want it done and are a reasonable candidate, you will be able to pay for it as a cosmetic procedure out of pocket and have no problem finding a surgeon to do your surgery. Expect the cost to be $8000 to $10,000. It sounds like do your question you are overweight, but not frankly obese.

Scott C. Sattler, MD, FACS · Answer

The insurance companies use antiquated BMI based tables to determines if a patient is eligible for breast reduction surgery. Surgeons know that higher BMI patients (>30) tend to have more surgical complications.

	If you think you are a good breast reduction candidate, and don't want to wait on an insurance company to 'approve' the procedure, then consider paying for this life-changing operation out-of-pocket. Several of my patients have done exactly that, and have told me that it was the best money they ever spent.

George Marosan, MD · Answer

Thank you for your question. You do not give your height and weight, age or any other medical problems, which go into the decision who is a good surgical candidate. We do breast reductions on patients who have higher than normal BMI's. It is a catch 22, to have large breasts that prevent you from exercising, yet everyone expects you to exercise and lose weight prior to surgery. You need to see a board certified plastic surgeon for an in person consultation and evaluation. Good luck.

Steven Wallach, MD · Answer

If you are severely overweight, then it is a good idea to lose weight first.  Being very obese can impact  safety as well.

Mennen T. Gallas, MD · Answer

In all elective surgery the first concern is that it is safe for you to undergo the planned procedure(s). BMI is part of that determination as is the rest of your medical history. If the surgeons you visited feel that it is unsafe for you to have the surgery you need to consider ways to bring that your weight down. Exercise does not have to consist only of running. Eating a balanced diet and engaging in a modified exercise program can be very beneficial. Good luck to you.

Lewis Ladocsi, MD, FACS · Answer

Hi LadyLaveau. Unfortunately, the best answer is that you need to lose weight! It is always safer to be close to your ideal body weight before having an surgery, because you reduce your risk of complications. Insurance companies generally cover breast reductions when the patient meets their criteria of symtoms of macromastia which cannot be controlled conservatively. Conservative management generally means: Weight loss and being close to your ideal body weight, medications to treat aches and pains, and physical therapy to strenghten her core muscles. I have had many patients at about your body mass get approved, but they generally met the other criteria. I suggest you work to reduce you weight, and speak with your plastic surgeon about this issue. It is also helpful to review the terms of your insurance contract.

Kelly Marie Sullivan, MD, FACS · Answer

It is a difficult situation when you have large breasts that are very uncomfortable and make every day activity difficult, but your BMI is high enough to put you into a high risk category for surgery (and general anesthesia). If your surgeon is recommending that you lower your BMI before you have breast reduction surgery, then I would assume it is because he/she wants to make sure the procedure will be successful and safe when it is performed (going along with the oath of "do no harm" - your surgeon is probably looking out for your best interests). It sounds like you have a good surgeon! However, it is also a bit of the "chicken and egg" situation where it is hard to exercise and lose weight when your breasts are very large and heavy. I would recommend that you look for a local place where you can do the Ideal Protein diet - a diet that will help you lose weight safely and quickly (around 3 pounds per week) so that you can get to the BMI range (around BMI of 30) that would make your surgery safe and successful. Good luck with everything - your surgery will be great and life changing when you are in the right position to proceed.

Ronald V. DeMars, MD (Retired) · Answer

Without your height and weight, your age and basic medical history we can't really answer tis question. If you like you can resubmit with appropriate info. ersonally I am willing to do breast reduction on patients with a BMI up to about 35-36 depending on their health.

Need Breast Reduction, Over BMI, What To Do?

Answers (8)

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