Would my scoliosis affect my chances of getting a breast reduction covered by insurance? (photo)

As breasts your size can cause back and neck pain, it can also be worse with scoliosis which should support an insurance claim for coverage.

Hello,Insurance coverage for breast reduction surgery varies by insurance company, your coverage, and certain criteria.Some typical symptoms are:Back, shoulder, neck painBra strap grooving of the shouldersRashes underneath or in between the breastsIt’s important to try conservative management to improve symptoms, such as weight loss, supportive bras, good hygiene, back massages/chiropractor, etc.Many times, these non-surgical options only give temporary relief and a surgical breast reduction will be necessary anyway.Some final criteria include the physical examination by your surgeon, some measurements of your breasts, pictures, and an estimated weight to be removed from each breast. This information is all sent to your insurance company for a “pre-approval” process.One of the most important criteria for the insurance company is the expected weight of breast tissue to be removed per breast. This is based on a preset scale, called the Schnur scale. This scale uses body surface area (BSA) to estimate the amount of weight to be removed per breast. You BSA is calculated by height and weight. Since you cannot change your height, weight loss is one of the best ways to improve your chances of getting insurance approval.Hope this helps. All the best and good luck!

Thank you for your question and the photo you provided. Back pain can be caused by a multitude of reasons, and some insurance companies want to make sure patients have done their due diligence to rule out other causes before paying out for a surgery. It may be beneficial to have your scoliosis evaluated by your physician. Weight loss may also be recommended. Be sure to consult with a board certified plastic surgeon to discuss your treatment pathway. Good luck! 

Thank you for your question.
You certainly appear to be a good candidate for Breast Reduction. Most insurance companies have minimum amounts of breast tissue that need to be removed. Please find an experienced Board Certified Plastic Surgeon near you who can examine you, help you with your concerns and also discuss insurance issues. All The Best !

As you might expect, each insurance company has their own qualifications for breast reduction approval. It certainly seems reasonable and appropriate for the insurance company to take this extra factor into consideration.

Dear Shea92,
it is hard to tell for sure without an examination but generally speaking, scoliosis will probably increase your chance of getting approval for breast reduction. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Hello and thank you for your question. In short, no scoliosis should not affect your ability to get your reduction covered. Actually, it may help since you are having back pain. Every insurance provider has different criteria or requirements that must be met in order to cover certain procedures. Based on your current complaints and your pictures, you should not have many issues getting that procedure covered. It ultimately depends on your insurance company. Keep in mind during your research, some plastic surgeons do not do accept insurance. Good luck in your search!

Hello Shea, and thank you for your excellent question. In short, all insurance companies have different criteria that they use to determine if breast reduction is covered. I do not believe that scoliosis would prevent you from having surgery. The criteria they use is most often based on photographic documentation, current bra size, duration of back pain, non-surgical management (ie weight loss, physical therapy, etc), and amount to be resected. 

 The fact that you have scoliosis and back pain may help you to get approved for a breast reduction. However remember that the insurance company decides how much needs to be removed.  And because of that it may make you substantially smaller than you would like to be. My concern with your photograph is that your breasts just look droopy and need to be lifted and not necessarily reduced as much. A lift alone will make the breast smaller but with your curves I think you would be happier to maintain a fuller volume higher on your chest  and not tremendously smaller. For example 500 g is a somewhat standard volume to remove from each side in a breast reduction. In your case that might be half of each breast. The best thing to do is see a plastic surgeon and find out what your insurance would require. Good luck

Thank you for your inquiry. In short, no, it won't affect your chances of being approved by your insurance.
Scoliosis can be one of the contributing factors of needing a breast reduction. There are many factors that an insurance company is looking for to approve you. Documentation of chronic back pain, neck pain, shoulder pain, shoulder grooves from bra straps, and/or rashes under the folds of your breasts are some of the things that insurance companies use to determine whether a breast reduction can be covered. Having large, heavy breasts and Scoliosis can contribute to many of these symptoms.