I’m a 32G and want to be a small C - would this be enough grams removed to qualify for insurance coverage? (Photos)

Question

I have my first appointment with my plastic surgeon in about two months. My insurance policy requires clinical documentation of symptoms (which I do have from my PCP and the first PA I saw in plastic surgery for my intake appointment) if tissue removal falls between 5% and 22% (282g-441g per my BSA). I’m a 32G (ABraThatFits measurements and it does fit good) and want to be a small C. May this be a plausible goal to achieve based on my photos for insurance qualification? I understand you can’t physically feel the weight through a picture but I’m trying to get an idea before my appointment. I have attached 4 different angles.

Gary M. Horndeski, MD · Answer

At size 32, each 100 grams removed corresponds to 1 cup size change.  To go from a G and to C would be 4 cup size, which would be 400 grams removed.  You may or may not qualify.

Best Wishes,

Gary Horndeski, M.D.

Tyler Frew, MD · Answer

Hi there,
Going from a 32G to a small C is a meaningful reduction, and it's very often in the range insurance will consider, especially since you already have your symptoms documented. Nobody can tell the grams from photos, though. Your surgeon estimates that at the exam.
A few things that help with coverage:
- Breast reductions are often covered by insurance when the paperwork is solid. Keep your notes from your doctor, plus any physical therapy, chiropractic care or pain treatment you've tried, and bring copies.- Your policy uses a sliding scale based on your body size, which is why your range is 282 to 441 grams per breast. Your surgeon's office will usually estimate your removal and submit for pre-approval before booking.- If they estimate you fall in the middle zone, your symptom records do the heavy lifting.- Even smaller reductions tend to relieve neck, back and shoulder pain well. Studies don't show that removing more grams means more relief.- Be realistic about cup size. Surgeons plan by what fits your frame and keeps a healthy blood supply, so think of "small C" as a goal rather than a promise.
An in-person exam is needed for personal advice, so this will all come together at your consultation with a board-certified plastic surgeon.
All the best!

Camille Cash, MD · Answer

From the submitted photos it appears you are a good candidate for a breast reduction.  This surgery has one of the highest satisfaction rates among plastic surgery procedures.  Your surgeon will be able to better assess if you will meet the insurance requirements, but from photos alone it appears you may.  I've included a video on this procedure that I hope you find helpful.

I’m a 32G and want to be a small C - would this be enough grams removed to qualify for insurance coverage? (Photos)

Answers (3)

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