I Am 5'6, 148 pounds 32-34 Ddd Am I Qualify for Insurance Coverage? (photo)

i am 22 years old. have one child(18 month old). my breasts started to be saggy and heavy sinse i was 13-14, i was 32-34d. after breastfeeding i got ddd. i am still brestfeeding but baby takes just left brest. so he doesnt take right brest for 6monthes(no milk in there but its still ddd size). back neck shoulders pain all included)))). and also if i will be qualified when should i stop brestfeeding before sergery? (hope to get answer on this quest)

Doctor Answers 9

Breast Reduction and Insurance

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Hi Valerie:

Getting insurance approval for breast reduction surgery can be tricky. You should be an excellent candidate, however insurance companies have lots of criteria that needs to be met. Breast reduction specialist usually have good office support that can help you get approval. We have found for our patients that even if the insurance company does not give approval, we can request a review and many times we get approval that way. You might want to have a consultation now so that you can get the process underway as it can take several weeks for approval. You will want to stop lactating before surgery and that can take 3 to 6 months once you stop nursing. Good luck!

San Francisco Plastic Surgeon
4.8 out of 5 stars 81 reviews

Breast reduction

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If you are still nursing, you are not a surgical candidate and you would need to wait 3-6 months afterwards to determine what size you actually are. Then you will need to establish medical necessity, subject to the conditions of your insurance coverage.

Breast Reduction Candidate?

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Thank you for the question and picture. Based on your picture and description I think you will be an  excellent candidate for breast reduction surgery; it is one of the most patient pleasing operations we perform.  It will be best for you to have stopped breast-feeding 3 to 6 months before the breast reduction procedure.

You will find that online consultants cannot with any degree of certainty predict whether a specific insurance company will cover the breast reduction procedure for you;  ultimately, you will you best off seeking in person consultation with well experinced board-certified plastic surgeons who can approach the insurance company on your behalf.

As  you think  about  breast reduction surgery make sure you do your homework and understand the potential risks and complications associated with  the procedure.   You may find the attached link helpful to you in this regard.  Unsatisfactory scarring is  one of the potential complications. Make sure you also understands that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

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.  

Be prepare to be persistent when dealing with health insurance companies.

Best wishes.

Qualifying for a Breast Reduction

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Candidates for #BreastReduction surgery are women who wish to have smaller #breasts to achieve a more proportional appearance or to alleviate physical discomfort. Breast reduction can correct symptoms from excessively #largeheavybreasts that may cause the inability to do certain exercises, or create back, shoulder and neck pain, poor posture, bra-strap shoulder indentations and chafing or rashes under the breasts. Women experiencing these discomforts may benefit from Breast Reduction, also called #ReductionMammoplasty. Furthermore, large breasts may interfere with normal daily activities or exercise and will be more comfortable when reduced. Women who feel that their excessive breast size decreases a sense of attractiveness and self-confidence, or results in unwanted attention are also candidates.

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 i 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.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Insurance Coverage

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Every insurance plan has their own unique criteria on whether they will cover a breast reduction. More and more, we are seeing plans where a breast reduction is not a covered benefit. If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage. Some set the amount in relation to your BMI (height and weight). Others require extensive medical records documenting neck pain, back pain, and history of rashes. The other alternative is to opt for a breast reduction as a self-pay option. Start by visiting with a board certified plastic surgeon to learn more about your options.
Best wishes,

Dr. Basu
Houston, TX

Breast reduction often covered by insurance.

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It sounds like you will have insurance coverage.  I wrote an article in my RealSelf profile about this, and you may find it helpful.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Breast Reduction Candidate While Breast Feeding?

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     Once you stop breast feeding, you should wait about 6 months to determine if you are a candidate.  If you have DDD cup breasts at that time, you will likely be a candidate. 

Insurance Coverage For 34DDD

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Valerie,  It would certainly seem that you would have your breast reduction covered by your insurance company with your sizes and your symptoms.  The only caveat is that some insurance policies have an outright exclusion for breast reductions in which case you would not be covered.


John Whitt, MD (retired)
Louisville Plastic Surgeon

Breast Reduction Information

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Based on your picture, you seem to be an excellent candidate for breast reduction surgery. I would recommend waiting 6 months after you stop breast feeding to determine your ultimate breast size which will help in determining the best procedure for you.  

My breast reduction patients are amongst my happiest patients. After surgery my patients always say, "Why did I wait so long to finally have surgery?" These women feel less self conscious and feel prettier. They can wear the clothes they want, they can exercise without pain, and often times their back and neck pain are improved.

Different insurance companies have different criteria for coverage of breast reduction surgery. After your consultation with a board certified plastic surgeon, he/she can help navigate the process, gathering all necessary documentation required to see if you qualify. Good Luck!

Scott Farber, MD
Boca Raton Plastic Surgeon
4.8 out of 5 stars 22 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.