What types of breast reduction procedures are covered by Insurance?

I see that there are many different procedures for breast reductions. My reduction would be covered by insurance. Which type does the insurance general cover?

Doctor Answers 2

Breast reduction

Thanks for your question.  The insurance companies in general do not specify the type of reduction performed (the choice of incisions, which areas of breast tissue to remove/keep, etc).  That is generally left to the physician's discretion.  Generally, the insurance companies do want an estimation of the volume of breast tissue to be removed as well as documentation for symptoms to show need for breast reduction.  Hope that answers your question.

Houston Physician
5.0 out of 5 stars 1 review

What types of breast reduction procedures are covered by Insurance?

Thank you for the question.  Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval.   Generally, 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.  Also, for many insurance companies, the closer you are to your long-term ideal weight, the better.

 This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.  Keep in mind, as you work towards your goals breast reduction surgery is one of the most patient pleasing operations we perform. Also, prepare to be persistent when dealing with health insurance companies. 

I hope this, and the attached link, helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,504 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.