1500 grams to be removed.

I think 1500 grams is excessive considering my size. I'm 5'10" and 270# (yes, I'm heavy), but they used their insurance company) one-size-fits-all formula to come up with that number. The doctor walked in and placed two implants (one 800 cc and one 700 cc) on the table and said, "This is what you'll need to have removed from EACH breast". He didn't examine me, told me I'd just have to visualize what it would look like, and basically said I didn't have a choice. Do all places operate like this?

Doctor Answers 8

Breast reduction grams to be removed

Breast reductions are based on measurements and what is proportionate to your body type. Insurance numbers are not a guideline for medical treatment. I would recommend discussing with your surgeon and ask more questions about your surgery. An examination with evaluating your breast measurements such as the distance from your sternal notch to your nipple is very important.

Chicago Plastic Surgeon
5.0 out of 5 stars 21 reviews

1500 grams to be removed.

First, I am sorry you had the experience you had as that is not typical for most plastic surgeons and a mandated 1500 gram reduction seems excessive. I would recommend you seek a second or even third opinion from other plastic surgeons in your area to review your concerns, perform an examination, explain the surgical and insurance predetermination procedures and make you feel comfortable in the process. We can help you with your weight issues as well as being in the best shape possible before surgery will lessen possible adverse issues. Good luck.

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 12 reviews

Concerns about breast reduction consultation…

Your plastic surgeon should be able to help you "visualize what it will look like" through the use of before/after photographs. If your intuition is telling you that you are not in the right place, seek second opinion consultations. Keep in mind, that 1500 gram removal does seem excessive, beyond what most insurance companies require.

 Make sure you are also aware of the potential risks/complications, some quite serious, of undergoing breast reduction surgery at your  weight. Make your decisions carefully. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

1500 grams

When you go in for a breast reduction consult the surgeon should be able to give you an estimate of the amount of tissue to be resected; it is only an estimate. If you feel that the surgeon is going for too much you should have another consultation. Can't give you much more info. without seeing you. 

Barry M. Schwartz, MD
Weston Plastic Surgeon
4.0 out of 5 stars 4 reviews

Insurance and BR

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

The short answer is NO

Many insurance companies want to be sure they're not paying for cosmetic procedures to they place minimums on the amount of tissue removed. I practice in Indiana and I'm not aware of any plans mandating 1500 grams be removed. 500, yes. 1500 gms is a huge reduction and I'd get a second opinion before proceeding. Good luck

Robert Frank, MD
Munster Plastic Surgeon
5.0 out of 5 stars 34 reviews

How many grams to remove to qualify for Breast Reduction Surgery

First, I am sorry that you did not have a good experience with your plastic surgery consultation.   When I see a patient for breast reduction surgery, I will first get to know her, get a medical history, ask her what symptoms she is having due to her large breasts, what her expectations are, what cup size she would like to get down to,  what type of activities she enjoys or would like to enjoy with smaller breasts.   

I will explain the entire procedure and recovery, and show her diagrams of the markings for the surgery, and before and after photos of my breast reduction patients.   I will examine and measure her, and give her my opinion as to how small she should get down to that would both relieve her symptoms and be proportionate to her body.  

If she is planning on submitting her information for insurance coverage, I will calculate that amount for her.   This is done using the Schnur Sliding Scale (SSS) using your Body Surface Area (BSA).  Your BSA with your height of 5'10" and weight of 270 lbs is 2.5 m2.   Using the SSS, the minimum amount of tissue is 1500 grams from each breast like the doctor told you, though not in a nice way.  If your breasts don't really decrease in size with weight loss, or decrease less than what the rest of your body would, you would benefit from first losing weight before surgery.  

Losing at least 50 to 70 or more pounds will significantly reduce your risks of complications from this surgery.   You will then not need to remove as much tissue, if you were, say 200 lbs.   Then your BSA would be 2.14 m2, and your minimum requirement from each breast would be 819 grams, instead of 1500 grams..... that is a significant difference.   Get a consultation with a physician who specializes in weight loss, and come up with a weight loss plan.  Also, go to a couple of more plastic surgeons who specialize in breast reduction surgery.  Your results with losing weight first will be significantly better!

Best Wishes!

Cecilia Franco-Webb, MD
Denver Plastic Surgeon
4.6 out of 5 stars 20 reviews

#breastreduction #insurance

If you want your breast reduction covered by your insurance, you will be subject to the medical policies that the insurance company issues. Most companies rely on a formula based on your height and weight to calculate the number of grams that must be removed from each breast before they consider the procedure "medically necessary"- which  means that they will pay for it.

While the way you describe your consultation seems abrupt, the fact is that your only other option is to pay for your surgery out of pocket as a cosmetic procedure. At that point, you can work with your PS to determine the number of grams to be removed without the insurance company directive.

Jack Peterson, MD
Topeka Plastic Surgeon
4.5 out of 5 stars 39 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.