Would Insurance Cover Teenage Breast Reduction, Size 32G?

Question

my daughter is 15 about 5'4 and 115 lbs. She is a 32G pushing into an H and she complains a lot about her back and she has had a few mental breakdowns. She has been going to physical therapy, but it only seems to make her worse. Would she be a good candidate for breast reduction even though she is only 15 and would insurance cover for it?

Craig S. Rock, MD, FACS · Answer

I have performed breast reductions on teenagers in the past, however there is the added risk that breast development may not be complete and the breasts may continue to grow after surgery.  Based upon your daughter's height, weight, bra size and failure of conservative management she may be a good candidate for the procedure.

	Check the exclusions page of your policy - if breast reduction is listed there, it would not be covered under any circumstances.  If the procedure is not an exclusion, you should be able to obtain a copy of your insurance carrier's "Clinical policy bulletin" for breast reduction, which will describe the requirements for coverage (eg. patient must be at least 18 years old, etc.).  Consultation with a board-certified plastic surgeon experienced in breast reduction should help you determine whether or not your daughter would be a good candidate for the procedure at the present time.

	Good luck.

Tom J. Pousti, MD · Answer

Thank you for the question.

	It sounds like  your daughter is dealing with juvenile breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for the frame causing  both physical and psychological distress.

	As  she thinks  about  breast reduction surgery make sure she does her homework and understands the potential risks and complications associated with  the procedure.  Unsatisfactory scarring is  one of the potential complications. Make sure she also understands that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

	On the other hand, breast reduction surgery is one of the most patient pleasing operations we perform and I think that for the right teenager (enough symptoms) it may be an excellent option (regardless of the age).
	Sometimes breast  reduction surgery is covered through health insurance. The best way to obtain insurance coverage for breast reduction surgery involves some &ldquo;hoops&rdquo; 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 &ldquo;authorization&rdquo; for the procedure. This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.

	Your daughter is very fortunate to have your support and understanding.

	Best wishes.

Anureet K. Bajaj, MD, FACS · Answer

Your insurance may cover breast reduction surgery for your daughter.  Keep in mind that some insurance plans may have restrictions on covering breast reduction, and may exclude the procedure outright or require that your daughter be eighteen.  

	I would recommend that you speak with a board certified plastic surgeon to determine if your daughter is an appropriate candidate for surgery as well.

	Good luck!

Thomas R. Walek, MD · Answer

I have performed breast reduction on many young women and some younger than fifteen. Each case must be individualized. No two cases are exactly alike. At this age one must consider the maturity of the patient both physically and emotionally. The risks and benefits must be clearly understood and the patient needs to be compliant with the surgical plan. 

	Personally, I would only recommend surgery if the symptoms were severe. The young women I have treated however have overwhelmingly been happy with the results. It is gratifying when I see one of these young women come in for late follow up and are happier, look better and look better dressed because they can buy off the rack outfits again. Wether your insurance pays,however is between you and your insurance company. Criteria vary so check your policy. Often the customer service people can refer you to someone that participates in their plan

E. Anthony Musarra II, MD (in memoriam) · Answer

That is a large size for an adolescent just going through puberty. I recommend her being checked by an endocrinologist (gland and hormone specialist) to be sure she doesn't have an abnormality of her pituitary or adrenal glands that could be causing this. Insurance will cover this depending on how much tissue is removed. Most insurance companies have a scale based on the patient's Body Surface Area that they use to determine if the surgery is necessary or not. You will need to have your surgeon request prior approval from the insurance company based on that information.

Alan M. Engler, MD, FACS (retired) · Answer

It is nearly impossible to predict what any specific insurance company will or won't do.  The general trend, though, is that it has become harder and harder to obtain insurance approval for breast reductions (at least, in my experience).  That being said, it sounds like someone with your daughter's physical comportment would, in general, be able to get insurance approval for a breast reduction.

	The complicating factor, of course, is that she is just 15 and at that age it may be difficult for her to fully appreciate the ramifications of this decision, which is obviously irreversible.  I have no doubt that she would obtain dramatic relief of her physical symptoms, but that will be in exchange for scars and a surgical process (surgery, recovery, etc).  While the vast majority of these patients do well (usually among the most successful of all plastic surgery procedures), a 15 year is, well, a 15 year old.  You should spend whatever time is required to explore this procedure fully, including having psychological guidance as support. 

	Assuming that all of that confirms her desire to undergo the procedure, I would be completely comfortable in moving forward with it for her.

	I hope that this helps, and good luck,

	Dr. E

Francis (Frank) William Rieger, MD (retired) · Answer

Breast reduction can be performed at any age, but most Plastic Surgeons would hope that the patient was at least eighteen years of age and had not changed her bra size for at least one year.  It would be such a dissappointment for the patient if she had the breast reduction performed and grew  in size after the reduction.  There is also an emotional  element to this if the  patient had to do the surgery again.

	 

	Please check with your local Plastic Surgeon about the possibility of having this covered by insurance.  In my practice I am not an insurance provider, but still give the patient  the codes for filing for the procedure, and many times the procedure will be reimbursed to the patient or her family in part, or fully.

	 

	Good luck to you.

	 

	Frank Rieger M.D.  Tampa Plastic Surgeon

John Whitt, MD (retired) · Answer

It is likely that insurance would cover your daughter's breast reduction with her symptoms and her failure to improve with conservative therapy. However, some insurance policies contain outright exclusions for breast reductions. Consult a BC plastic surgeon who can discuss the procedure with you and your daughter and communicate with the ins. co.

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