Breast reduction surgery is typically considered medically necessary when it may help to alleviate physical symptoms caused by overly large breasts. Insurance companies have varying criteria, but may approve the procedure if the patient demonstrates the following criteria: -Symptom Documentation: A history of back, neck, and shoulder pain, as well as shoulder grooving from bra straps, chronic rashes or infections under the breasts, and poor posture. -Failed Conservative Treatments: Documentation that conservative treatments, such as physical therapy, medication, over-the-counter pain relief, or supportive bras, have not resolved the symptoms. -Amount of Tissue to Be Removed: The amount of breast tissue to be removed is often a determining factor. Many insurance companies require that a certain amount of tissue (e.g., 500 grams or more per breast) be removed. The criteria vary by insurance provider, and some may require more or less based on height, weight, BMI, BSA, and breast size. -Pre-Authorization and Documentation: Often, insurance companies will request additional documentation from healthcare providers (such as primary care physicians and physical therapists) that confirms the necessity of surgery. Breast reduction surgery may often lead to a significant reduction in discomfort, depending on the severity of their symptoms and the amount of tissue removed. There is no guarantee of symptomatic relief or cup size. The reason for this is that neck/back/shoulder pain may be multi-factorial, and not only related to breast size. It is important to consult with an experienced plastic surgeon who can customize your surgical plan and determine the best technique for you based on your individual anatomy and goals. Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York