I Want to Know if Im a Good Candidate for Breast Reduction?

I have had big breast all my life i started developing in the 3rd grade. I am 5'3 and i weigh 244 i have lost 20 pounds in the last 2 months. Im bra size is a 48DDD and i want to be a 36c and i have back and shoulder sometimes neck problems.My insurance is medicaid All I want to know is will my insurance approve me for Breast reduction"

Doctor Answers 5

Breast Reduction Candidate?

I'm sorry to hear about  the problems your breasts have caused, starting at an early age.Based on your description you may be a good candidate for breast reduction surgery; it may be in your best interest to drop weight first. Reaching your long-term stable weight prior to undergoing breast reduction surgery will help minimize the risks associated with the procedure and help minimize the chances that further surgery will be necessary in the event of future weight fluctuation.

Unfortunately,  online consultants will not be able to definitively state whether  any specific “insurance” will cover your  procedure. You will need to check with board-certified plastic surgeons in your area  and ask to see doctors in consultation ( who still work with Medicaid).

  Undoubtably there will be some some “hoops” to jump through. 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.  

Good luck with your  goals;  breast reduction surgery tends to be one of the most patient pleasing operations we perform.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

I want to know if I'm a good candidate for breast reduction?

Hello! Thank you for your question.  It is a safe procedure, in which your plastic surgeon will reduce the amount of breast tissue, reshape your breasts, raise the nipple-areolar complex to its appropriate position (possibly making the size smaller, if needed), and ultimately ameliorate the possible complaints that you do have for the reason that you are having this procedure (e.g., neck/back pain, migraines, rashes/infections, shoulder grooving, etc).

It would be in your best interest to lose weight prior to surgery to minimize the risk to you as well as have a mammogram prior to the procedure for screening prior to this procedure, as the architecture imaging of your breast will slightly change afterwards. Well known data exists that having a breast reduction will in fact lower your chance for developing breast cancer, simply because the amount of tissue will be less.

Consult with a board-certified plastic surgeon who will discuss the procedure with you, examine, and assist you in determining if this is the right procedure for you.  Voice your complaints - your insurance will likely require a detailed description of your history and complaints as well as photo and an estimate of how much tissue will be removed.  You should give a description of the therapies that you have done to ameliorate your complaints thus far.  Any other notes from other physicians is helpful.  It would also behoove you to discuss your issues yourself with your insurance carrier.  Hope that this helps!  Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Insurance coverage

I am not familiar with Medicaid, but I can comment on private insurance.  Every insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.

Best wishes,

Dr. Basu
Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

Breast reduction and medical necessity

From your description you would appear to be a good candidate for a breast reduction.   You need to continue to loose weight.  Your BMI is greater than 40 which places you in the obese category.  At your weight you are at a significant risk with any surgical procedure.  You need to continue to loose weight preferably get your BMI to below 30 this means loosing an additional 65 pounds.   Medicaid is not insurance and to qualify for a procedure under terms of Medicaid will vary from state to state.   If you have lost 20 pounds over the past 2 months, keep going it will certainly improve your odds of getting medical approval for the breast reduction surgery.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Breast reduction candidates - who is good?

Thank you for you letter.  If you e

were to come to me for a consultation I would advise you to continue losing weight down to a reasonable weight for your. Height.  I doubt Medicaid would cover you at your weight and you would have to pay out of pocket.  Although you could reduce your cup size you can't reduce the size of the chest wall from a 48 to a 36.  Keep up the good works you have started and lose the weight then you will get a better result in the long run   Good luck, Dr. Schuster inBoca Raton


Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.