I am a size 34H and looking into breast reduction and wondering what the chances of having Medicaid cover this?

Question

I have lack of curvature in my neck/arthritis and pain. and I'm a normal wieght at 5"4 and 140 lbs and live in Washington state.

Urmen Desai, MD, MPH, FACS · Answer

I recommend an in-office examination as well as 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 (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Kenneth Hughes, MD · Answer

None of us can predict what decisions insurance companies will make regarding coverage for BR surgery, what documentation will sway their decision, or the length of the approval process. BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered by most medical insurance providers.  If not, they may try to deny you based upon a lot of things such as lack of symptoms, lack of previous medical management, and lack of enough tissue that should be removed. The insurance companies will dictate the amount of tissue to be removed, not the PS.
Read your Medicaid medical insurance certificate of coverage and find a PS who will accept their reimbursement. Determine what medical information is required for your insurance provider to issue a pre-authorization or predetermination of benefits for BR surgery. Seek consultation with a board certified PS who can evaluate your medical condition and history, discuss the pros and cons of this surgery as it applies to you, and help you in completing the paperwork required.  
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Gary M. Horndeski, MD · Answer

At size 34, each 100 grams removed corresponds to 1 cup size change.  Medicaid usually requires a minimum of 500 gram removal, which would put you at a size C.  This may be too small a size for you to find acceptable.  The traditional breast reduction techniques results in ugly vertical scars, loss of nipple sensation and the inability to breast feed.  The technique I recommend is The Bellesoma Method.  This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevated them higher on the chest wall and more medial to increase your cleavage.  The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  Medicaid does not cover this technique.    Best Wishes,Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear caityhope,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.
If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Miguel Delgado, MD · Answer

It is pretty unlikely that you will find a surgeon willing to accept Medicaid (if they would even cover it) as their reimbursement is very low. You might try a teaching college near you as many times they offer surgery performed by their residents at a reduced cost. Good luck.

Scott C. Lindsay, DO · Answer

Hello and thank you for your question.
In order to have your health insurance cover your breast reduction surgery you have to meet certain criteria.  Contact your carrier to see what your benefits are. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

Jon Ver Halen, MD, FACS (license suspended) · Answer

Dear Caityhope,
Hello and thank you for your excellent question. You should be evaluated for a No-Vertical-Scar breast reduction. There are a number of no-vertical scar breast lift techniques, but my preferred technique is the Bellesoma Breast Lift technique. Our technique provides an exceptional breast lift, upper pole fullness, relief from neck and back pain, and no vertical breast lift scar. It uses a woman’s OWN breast tissue to produce an internal suspension technique and breast augmentation, without the need for a breast implant. It does not disturb the nipple, areola, or breast glands, so sensation and the ability to lactate is preserved. It uses 3D scanning of your breasts and body to design a procedure specifically designed for YOU, and you alone. Finally, for patients who desire breast enlargement, it can be combined with fat grafting. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. Preoperative visualization with Crisalix can simulate what your body will look like after surgery and can help you make your decision. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. Good luck!
  
Best,
  
Jon Ver Halen, MD FACS
  
Harvard educated plastic surgeon
  
Double Board Certified Plastic Surgeon

J. Michael Morrissey, MD (in memoriam) · Answer

Thank you for your question. Breast reduction really is a wonderful, life changing operation. It provides a relief of the neck and back pain and shoulder strap grooving, improves posture and generally improves  body image. My best recommendation would be to go to a university hospital near you for an evaluation and consultatioin. My reasoning for this is that Medicaid is typically accepted at University Hospitals. Plastic surgeons in private practice do not always accept Medicaid reimbursement.Best wishes to you. Breast reduction really is a wonderful, life changing experience. You will not regret it . Dr. Morrissey

Ronald V. DeMars, MD (Retired) · Answer

Breast reduction is a life changing operation for patients having symptoms from oversized breasts and is frequently covered by health insurance. The only way to find if you qualify would be first find a plastic surgeon that accepts Medicaid patients, then visit with the surgeon for a consultation. Best of luck.

I am a size 34H and looking into breast reduction and wondering what the chances of having Medicaid cover this?

Answers (9)

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