People are asking about 400-500 grams. My insurance will only approve if it's 745 grams per breast. Is that normal for a 38F?

This seems like a very large volume to remove and may make you pretty small.  I recommend a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery, a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Although obviously every case is different, you are correct that 400 to 500 cc's seems to be typical.  I have no idea why your insurance company want 745 grams removed, seems a very arbitrary number.  You are your best advocate in getting this authorized.  If you bug the people at the insurance company enough I am convinced you will get this authorized.  Your expectation of ibsurance coverage is perfectly reasonable.

dear Patient: I'm so sorry you have to endure this process! Each insurance carrier has their specifics as to what they will cover. I have seen so many patients that qualify...and then be denied coverage for reasons like the one you list.  Consult only with Board certified plastic surgeons that are experts in this procedure! I have done thousands of Breast Reductions and have to agree with othet collegues that its one of the most rewarding surgeries I perform! Patients are happy For this lifechanging procedure! Best of luck!

The equation that the insurance company uses is usually based on your height and weight.  They calculate the body surface area (BSA) and based on a sliding scale, determine the amount of breast tissue that needs to be removed in order for them to consider it medically necessary.Not that there is much difference in 100 grams when we are talking about 600 vs 700, but unfortunately they are sticklers and that is what they go by.  The one thing you don't want your surgeon to do is to be restricted to a certain amount and have to remove that amount in order for insurance to cover the procedure.At times we see patients that don't qualify for insurance paid reduction and choose to pay for the procedure themselves.  They wind up still very happy and have an improvement in their life and daily living.  Hope that helps.

It's really kind of crazy.  You carry around so much weight that your neck and back and shoulders ache, and bra straps dig into the shoulders.  You jump through all the hoops the insurance carriers put in front of you, like physical therapy, weight loss, and chiropractors.  You finally visit with a plastic surgeon who says you'll benefit from breast reduction surgery, but "let's see what your insurance says".  Then 'boom'.  The insurance company says yes, it's a covered benefit, but only if a semi-random amount of tissue is removed from each breast.  The insurance companies now all have their own requirements; each company is different than the other.  If you 'Google' your insurance company's name and 'breast reduction', you're likely to find the specific rules they go by.  They'll often list published studies as references.  In the end, despite appeals, the insurance companies usually stick to their guidelines.  In those cases it can be pretty disheartening.  We see it quite a bit.  We are seeing more and more women who were denied by their companies paying for the procedure out-of-pocket.  Women who go through breast reduction tend to be some of the very happiest patients in my practice.  It is common to hear "I wish I'd done it 20 years ago".  It would just be nice if the insurance companies would make the process easier.

it is difficult to answer this question without examining you, however, I have reduced more than 1000 g from each breast of a womann that was a 38 F and she was still a large 38DDD following the procedure.  It depends also how much skin is removed so there is more than just breast tissue weight to consider.  Best of luck!DSR

Your situation is not abnormal and it is very common for the insurance companies to look at a chart rather than the patient.  They primarily don't want to cover your procedure and look for ways to deny coverage.  If you really need a reduction and it sounds like you would benefit from this procedure you may need to pay out of pocket or just accept the results if more is taken off.  I would listen to your surgeon and possibly get more opinions to make sure you get what you want and need.  Most surgeons will under estimate how much they will take off rather than over estimate to make sure they get the required amount.

Unfortunately the insurance industry sets the standard for the amount of grams removed.   As you stated they base it on your height and weight.  You can try and appeal their decision but they are not likely to approve.  Good luck.

The weight required to be removed by insurance companies for a breast reduction are based on your height and weight which then calculates the B.S.A. which then determines minimum amount weight to be removed based on a Schnur Chart that can be found on the internet.

The insurance company has no interest in you having this surgery and most companies set artificially high weight limits in order to avoid having to actually cover the surgery even though they say they cover it. You will need to listen to your surgeon who has your best interest and your health at heart and you may have to pay for the surgery out of pocket. At least 75% of my reduction patients do that as they fail to meet the insurance company's unrealistic standards. If you do pay it will be one of the best investments you ever make.