OHIP Breast Reduction Coverage?

Question

Hello I am 19 years old and seeking a breast reduction for medical reasons. I feel a lot of psychical pain and discomfort from having larger breast especially since I have lost over 50 lbs. I am 5’7, weigh 140 lbs and my bra size is a 34DDD. I was wondering if (in your personal opinion) I would be a good candidate for a medical breast reduction and if OHIP would cover my surgery.

Scott C. Lindsay, DO · Answer

Hello and thank you for your question.
You may be a good candidate for a breast reduction. It would be best for you to have a in person consultation with a board certified plastic surgeon, Call your Insurance company and check if breast reduction surgery is a covered benefit and what the guidelines are.  Best of luck!

Kenneth Hughes, MD · Answer

None of us can predict what decisions medical insurance companies will make regarding coverage for BR surgery or what documentation will sway their decision. 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 medical insurance. If not, your medical insurance 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. 
Read your OHIP certificate of coverage. Determine what medical information is required for your OHIP to issue a pre-authorization or predetermination of benefits for BR surgery. Then seek consultation with a board certified plastic surgeon who can evaluate your medical condition, discuss the pros and cons of this surgery as it applies to you, determine the amount of tissue to be removed, and help you in completing the paperwork required by OHIP. (Take all documentation you have accumulated to your board certified PS's consultation appointment.)

Gary M. Horndeski, MD · Answer

At size 34 DDD, each 100 grams removed corresponds to 1 cup size change.  You may or may not fall into the category of approval by OHIP.  However, the technique I recommend is The Bellesoma Method.  This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate 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 (in 95%) and the ability to breast feed are maintained.  This technique is available in Toronto by Dr. Kara.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Intelligent4220,
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

OHIP Breast Reduction Coverage?

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