Does Ahcccs cover breast reductions due to discomfort and pain? Would they be able to remove excess skin?

Question

Hi I am 23 and I am a 38DDD In most bras After having my daughter my boobs have lost all elasticity and are very heavy. If I wear a bra for even 30 minutes and take it off my boobs ache bad on the sides all the way to my arm pits. The straps to my bra dig into my shoulders and make it to where I can’t wear one from pressure. Also if I was to be able to get a reduction would they take the excess skin that causes them to be heavy and sag as well or would I be left with flat sagging breasts?

Tom J. Pousti, MD · Answer

Based on your description, you seem to be an excellent candidate for breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.  When a breast reduction is carried out, the "excess skin" is also removed (breast lifting).Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy. Then, given that every insurance company has different “criteria”, best to identify exactly what your specific insurance company considers criteria for approval. Generally, the more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.  Also, prepare to be persistent when dealing with health insurance companies.  Ultimately, the most important decision you make will be careful selection of plastic surgeon.  Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as well.   In our practice, this is best done with the help of goal photographs and computer imaging.
Working together you will come up with a good plan to achieve your goals.  Best wishes.

Kenneth Hughes, MD · Answer

None of us can predict what decisions 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 weight, lack of symptoms, lack of previous medical management, and lack of enough tissue that should be removed. 
Read your medical insurance certificate of coverage. Determine what medical information is required for your medical insurance company 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 your medical insurance company.  (Take all documentation you have accumulated to your board certified PS's consultation appointment.)

Daniel Barrett, MD · Answer

Dear Koropeza96,
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

Donovan Rosas, MD · Answer

Candidates for breast reduction will typically have documented evidence of neck/back and shoulder pain as well as rashes and bra strap grooving attributable to the increased breast weight. They will often demonstrate that these symptoms have been resistant to more conservative measures like therapy, weight loss and pharmacologic intervention.
In addition to establishing a case for medical necessity, there are also requirements for resection weight (when covered by insurance). This may be a standard "500 gm per side" stipulation or a more variable standard based upon body surface area/Schnur scale. It is important to realize that these weight requirements can occasionally exceed your goals for size reduction. Insurance coverage is contingent on these requirements being met, thus cosmetic concerns become secondary(i.e. cup size goals).
Based on your narrative, you would seem to be a reasonable candidate. The absolute requirements from each insurance provider will vary but that being said your clinical narrative checks all the proverbial boxes. 
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Top 100
RealSelf Hall of Fame

Gabrielle B. Davis, MD · Answer

Breast reduction surgery would include removing excess skin in addition to excess breast tissue.  While one of the focuses of breast reduction is to relieve unwanted symptoms due to the heaviness of the breasts, overall aesthetics and attractiveness of the breasts are goals of breast reduction as well.  Please let me know if you have any additional questions.

Does Ahcccs cover breast reductions due to discomfort and pain? Would they be able to remove excess skin?

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Does Ahcccs cover breast reductions due to discomfort and pain? Would they be able to remove excess skin?

Answers (5)

Answer: Coverage of reduction

Answer: Coverage of reduction

Answer: Breast Reduction Question

Answer: Breast Reduction Question

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Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.