I'm 29 years old, 5' 4, 38 DD, and 208lbs with chronic back and neck pain, could I qualify for a breast reduction? (photos)

My breasts are not proportionate as you can see from the photo's and I have to wear 2 bras on a daily to support myself. Jogging, and even sitting up right at a desk for hours is extremely uncomfortable. I have been a size DD since I was 12. Even when I had weighed less in my past my breast size has never fluctuated. My back and neck pain is consistent and I can crack both areas multiple times just practicing good posture. Could I qualify for a breast reduction through insurance?

Doctor Answers 8

I'm 29 years old, 5' 4, 38 DD, and 208lbs with chronic back and neck pain, could I qualify for a breast reduction?

Thank you for the question. I am sorry to hear about the problems your disproportionately large breasts are causing; based on your description, you may be a good candidate for breast reduction surgery. Best to undergo elective breast surgery once you have reached your long term stable weight.  “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 (and improve symmetry). 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.

Sometimes breast  reduction surgery is covered through health insurance.  unfortunately, online consultants will not be able to help you  when it comes to predicting whether your specific policy will cover the procedure, or not.  A phone call to the insurance company may be a good place to start. 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.  Also, when it comes to dealing with health insurance companies, it may pay to be persistent. It will also be important that you communicate your goals with breast reduction surgery carefully; discussing goals in terms of achieving a specific cup size can be a source of miscommunication and/or disappointment. In my practice, I find the use of goal pictures helpful.

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

San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Insurance Coverage for Breast Reduction Surgery

There is no doubt that breast reduction surgery will alleviate your symptoms.   Having performed over 1,000 breast reduction surgeries in my 23 years as a board certified plastic surgeon, I have witnessed the relief patients feel and the gratitude that they have with smaller, lifted and more shapely breasts.  

In addition to consulting with a plastic surgeon, you should find out from your insurance company what their requirements are for coverage.   Many insurance companies use the Schnur Sliding Scale to determine the minimum amount of breast tissue that needs to be removed to be covered under insurance.   This is done by first calculating your Body Surface Area (BSA) using your height and weight.   Yours is 2.10 m2.  Using the Schnur Sliding Scale chart, you would need to have at least 750 grams of tissue removed from each breast.   That is a large amount to remove, and from your photos, would possibly be almost all of your smaller right breast.   

If you were to lose weight, your BSA would be less and so would the minimum breast tissue requirement.   

Best Wishes.  You would definitely benefit from smaller, lifted and evened out breasts!

Cecilia Franco-Webb, MD
Denver Plastic Surgeon
4.6 out of 5 stars 20 reviews

Do I qualify for a breast reduction

There is a variety of issues that a insurance company will evaluate.  Your symptoms, weight, medical condition and breast size.  You should start with your primary care doctor to refer you to a plastic surgeon for further evaluation.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 75 reviews

Breast reduction

See your primary care physician, pediatrician or gynecologist to start the process.  He or she will be able to refer you to a trusted plastic surgeon and guide you through the process. There are criteria you must meet. It would be in your breast interest to lose some weight before undergoing surgery.  My calculations say that you are not at the best weight to have the surgery in terms of wound healing and anesthetic risks.  Approach this with your doctor before visiting with the plastic surgeon.

R. Laurence Berkowitz, MD
San Jose Plastic Surgeon
4.7 out of 5 stars 13 reviews

Breast reduction

There are several criteria that must be met in order for a breast reduction to be approved by insurance.  A consultation with a board certified plastic surgeon can help you understand your options and if you are a good candidate for the procedure.  

Josef Hadeed, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Could I qualify for a breast reduction?

Physically you are a good candidate for breast reduction, but the only way to answer your question would be to see a surgeon for consultation and then have the surgeon's office contact your carrier. The insurance will have set numbers for what tissue weight needs to be removed and also requirements that you have tried physical therapy, weight control, antiinflammatories, etc as they want to put as many roadblocks in your way as possible to avoid paying for the surgery. Way over half our reduction patients pay out of pocket due to poor insurance coverage.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

I'm 29 years old, 5' 4, 38 DD, and 208lbs with chronic back and neck pain, could I qualify for a breast reduction?

You are a great candidate for breast reduction surgery. Consult with your local plastic surgeons to discuss your goals with surgery. Thanks for your question. Best wishes.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 164 reviews

You will feel so much better!

Hello. I think you will be able to have insurance cover your surgery. Your doctor will need some documentation about the problems you have related to the large size of your breasts. Your back pain should  resolve and as an added bonus- you will have more symmetrical breasts  My patients tell me their backs feel better the very next day!
Breast Wishes!

Anne Taylor, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 38 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.