How do I get my underage daughter breast reduction surgery? (Medi Cal)

From your description it seems as if you are a good candidate for breast reduction. Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses

Your daughter should go with you to consult a plastic surgeon, or several, to learn more about the procedure, what to expect, and what steps should be taken if you both agree to proceed.  When you have more information, the best course will become clear.

can certainly be done if your daughter and you are willing to accept the risks and scarring of the procedure.  Though anticipated to help with back pains, there is no guarantee that it will.  And then the most challenging part becomes finding a participating plastic surgeon... you may be best going to medical centers with training programs to get started. 

I'm sorry to hear about the physical and (possible) psychosocial problems your daughter's disproportionately large breasts are causing her. It is probable that she is dealing with juvenile breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In my practice, timing of breast reduction surgery is determined on a case-by-case basis. It is not too early to do your homework and learn as much as possible about breast reduction surgery and the potential risks and complications associated with the procedure. As she learns about breast reduction surgery, make sure she reads about the potential risk/complications associated with the procedure. You may find the attached link helpful in this regard. For example, unsatisfactory scarring is one of the potential complications. Make sure she also understands that further surgery may be necessary in the future (for example if the breasts were to grow in size again).On the other hand, breast reduction surgery is one of the most patient pleasing operations we perform and I think that for the right teenager (enough symptoms) it may be an excellent option (regardless of the age).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.

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

Hi Ktmyr,If both you and your daughter feel that she would benefit from a breast reduction then you should schedule an appointment with a BSPS. He or she will be able to give you an honest evaluation of the estimated amount of reduction that can occur. You also need to be aware of the downsides of surgery which can result in scaring, nipple sensation changes, and possibly a decreased ability to breast feed in the future. If you are hoping to get this covered by insurance, then a letter from the physical therapist might help. Too bad her PMD does not think the reduction would help your daughter, since a letter from him might be useful.Don't give up being an advocate for your daughter. Good Luck!