Would insurance cover a reduction, and would this procedure help the fibrocystic pain?

Question

I have large breasts (36DD or 38D) that are heavy and pendulous from weight loss/pregnancy. I have neck/shoulder/upper back pain and my straps always leave a mark from having to hold them up. Large areolae. No rashes, but I do have some skin growths (like moles) that tend to form under skin folds under each breast. To compound this, my breasts are fibrocystic and painful, severely with my cycle. Would insurance cover a reduction, and would this procedure help the fibrocystic pain? Thanks!

Tom J. Pousti, MD · Answer

Thank you for the question and pictures. Based on your description, you may be a good candidate for breast reduction surgery. “Official” recommendations of course would necessitate in-person consultation.
Breast reduction surgery is one of the most patient pleasing operations we perform. By removing “excess” breast tissue, adipose tissue, and breast skin  this operation reduces AND lifts the breasts to a higher position on the chest wall (in other words, the breasts are "automatically" lifted when a breast reduction is performed). By doing so, patients often find improvement in neck, back, and shoulder discomfort and find it easier to form their activities of daily living and exercise. Given that a significant amount of breast tissue is typically removed, it is possible that pain secondary to fibrocystic disease may be decreased, but it is not possible to predict/promise this improvement with any degree of certainty.
Timing of the operation will depend on the patient's life circumstances. Sometimes breast  reduction surgery is covered through health insurance. 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.
When the time is right,  seek consultation with well-trained/experienced board-certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly. Best NOT  to communicate your goals in terms of achieving a specific cup size; this type of communication can be a source of miscommunication. In my practice, I prefer the use's is in mof goal pictures during this communication phase;  many patients wish to remove enough breast tissue to improve/alleviate symptoms while maintaining upper/lower body proportionality.

I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps.

Larry S. Nichter, MD, MS, FACS · Answer

Here are some basics about Insurance Coverage Criteria for approval for Breast Reduction. Breast Reduction varies from insurance company to insurance company. In your case: The more Physician recommendations for breast reduction the better - that would include your gynecologist, primary care doctor, plastic surgeon, chiropractor, etc. They want to see that you have already tried non surgical means such as weight loss, physical therapy, chiropractic treatments, etc but still have problems.. Contact your individual company and request their specific Criteria.

Steven Wallach, MD · Answer

It is difficult to say whether or not your insurance will cover your reduction. The first thing that you can do is call you insurance company to find out their criteria for approval.

Stephen M. Chen, MD · Answer

Thanks for asking a very good question.  For you to qualify for a breast reduction the following criteria need to be satisfied:1.  Documented neck, back, or shoulder pain, bra strap grooving or rashes due to large breasts2.  Documentation of failure of conservative management (ie. medications, support bras, physical therapy)3. 
 Documentation from a chiropractor, back surgeon, neurologist that neck 
and back pain is being exacerbated by having large breasts.4.  Documentation that the amount of breast to be resected will satisfy the Schnurr scale which is based on your height and weight.In regards to the fibrocystic disease there is no correlation that I am familiar with to associate the amount of breast tissue that is taken with the amount of pain relief.  The first step is to have your complaints documented by your primary care provider.  Step 2 is to come and get evaluated by a plastic surgeon.

Would insurance cover a reduction, and would this procedure help the fibrocystic pain?

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Answer: Will insurance cover my breast reduction? Will it help with fibrocystic pain??

Answer: Will insurance cover my breast reduction? Will it help with fibrocystic pain??

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Everything you need to know about Breast Reduction

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Would insurance cover a reduction, and would this procedure help the fibrocystic pain?

Answers (4)

Answer: Will insurance cover my breast reduction? Will it help with fibrocystic pain??

Answer: Will insurance cover my breast reduction? Will it help with fibrocystic pain??

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.