I/J cup, spondylosis, scoliosis & back pain - does my state ACCHHS insurance cover a breast reduction?

You may qualify, but your primary care physician will need to refer you to a plastic surgeon. Many insurance companies also require that you have been treated for at least 3 months for back pain, rashes, etc.

Hi,

Thank you for the question.

Based on what you are describing, it does sound that you have large/heavy breasts causing physical symptoms, and breast reduction may be an option for you. However, it is difficult to tell without seeing the photos and/or in person consultation.

Schnur Sliding Scale is a scale used by many insurance companies as a guideline for how much breast tissue should be removed in order to improve your physical symptoms. In addition, most insurances in order to approve the surgery, will require for 2-3 letters of medical necessity (from your chiropractor, primary doctor, OBGYN, Dermatologist, etc) demonstrating that your physical symptoms due to large breasts are not improving with conservative management.

The goal of breast reduction surgery it to make the breasts smaller and lifted, but also proportionate with the rest of your body.

I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.

I hope this helps.
Best regards, Dr. Karanetz

Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon

From your description it seems you would benefit from a breast reduction. I encourage you to contact your insurance provider to check coverage and criteria. Some carriers may cover a breast reduction but only after certain other pain relief options are tried (physical therapy, etc).