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

Question

I have the state ACCHHS insurance and I want to get a breast reduction. I was diagnosed recently with thoracic spondylosis and slight scoliosis. My back pain has been very extreme. My breasts increased in size during my pregnancy and are now a 34I-36J based on measurements. I a hoping to get down to a D or DD. I don't wear bras most of the time because they dig into my skin, but when I do, I wear tighter sport bras. I have been losing weight but not breast sizes

Irena Karanetz, MD · Answer

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

Ronald J. Edelson, MD · Answer

I don’t know if state insurance would cover it. You would be best off going to the university hospital where they can better figure out if you are eligible. Also state insurance pays the doctor so poorly you would have a hard time finding a plastic surgeon in private practice willing to do it.

Connie Hiers, MD, FACS · Answer

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.

Camille Cash, MD · Answer

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).

Mats Hagstrom, MD (license on probation) · Answer

And insurance policy is a financial contract. And each policy there will be described benefits, describing what covered.
All insurance carriers will have policies available to the persons who have that insurance plan.
Generally speaking, symptomatic, macromastia, is a condition that virtually all medical insurance companies.
Companies may have criteria for who is covered for it and who it’s not. This varies based on each policy.
I suggest having a few in person, consultations with plastic surgeons, who accept your particular insurance.
Best,
Mats Hagstrom, MD

Kamil Manav, MD - Account Suspended · Answer

Hello,I appreciate your question. Without a photo, I can’t provide a very precise assessment, but based on your bra size, it seems you have significantly large breasts. Large breasts can lead to issues such as shoulder pain, back pain, neck hernias, rashes under the breasts, difficulty in moving comfortably, and challenges in finding well-fitting clothing. Pregnancy and weight fluctuations can also cause changes in breast size. The only solution to alleviate all these complaints is breast reduction surgery. With this surgery, you can achieve a breast size that is anatomically suitable for you.

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

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