Breast reduction. Will my BMI affect whether or not I can have the surgery?

In my own practice I've studied the subsequent benefits to patients after breast reduction. The vast majority of patients went on to lose substantial weight. When asked they said that the physical imposition of the large breasts restricted activity and after the reduction they became more physically active.

There may be two parts to answer your question and thank you for asking it:1)  It has been long recognized that patients with lower BMIs have fewer healing problems.  Higher BMIs (above 30 and particularly above 35) in breast reduction patients give you a much higher risk of having wound breakdown issues and possibly other healing issues such as a fluid collection.  Risk of these problems also seems to go up with very large volume breast reductions.  There are also higher risk of forming a blood clot in your leg around the time of surgery (also known as a DVT) or having a blood clot go to your lung (known as a PE or pulmonary embolus).  Higher BMI are also associated with higher rates of pulmonary issues such as sleep apnea that can complicate surgery and higher rates of other disease such as diabetes which can raise infection rates.  So, for the safety of the patient and lowering the overall risks associated with an elective surgery, it is preferable to lose weight and be at a lower BMI.  However, depending on your overall health, you may still be a candidate for such surgery (understanding your higher risk) after consultation with a plastic surgeon who can help assess risk for you.  Many of us will want you in a safer weight category prior to surgery.2)  From an insurance standpoint (when patients are trying to get insurance to preauthorize the procedure), attaining authorization for breast reduction becomes a bit harder when your BMI is higher.  Insurance wants to see documentation of symptoms related to large breasts and they also want to see that conservative measures have been tried to get relief before surgery.  They want to see measurements taken from the plastic surgeon and the estimated weight of breast tissue which would be removed during a breast reduction.  Most now have BMI charts which plot out the expected weight of breast tissue given a patient's BMI.  For a BMI of 40, many insurance plans want to see that over 1000 grams would likely be removed from each breast to give authorization.  That is indeed a large breast reduction and many women with large breasts fall short of that mark.  I also sometimes see patients that want to lose weight and plan to do so after a breast reduction.  The problem with that is you usually have optimal breast shape, skin tightness, and size after a breast reduction.  If you lose substantial weight after a reduction, you may notice droop and a loss of that tight look.  Also, your breast size could become smaller than you wish as a result of the weight loss/body fat loss.  The most predictable long term result is obtained when patients lose the weight they wish to lose before surgery.So, you certainly may be an excellent candidate to get relief from a breast reduction.  However, it may be in your best interest to lose a bit of weight preoperatively.  Even achieving a BMI of 35 or 36 may limit some of the risks I discussed above.  I know that that is no easy task but I believe that a selective diet is the key for adult weight loss (much more so than exercise that is made difficult by larger breasts).  Good luck to you!