I wear a 32ddd. is there a chance insurance will cover a breast reduction? (photo)

Question

I've been suffering for the past year. Bad posture, back pain and uncomfortableness. Excercising and being active is hassle, having to wear two sports bra. I bulge out of every bra I own in the front and finding shirts that fit both my waist and my boobs is hard. I've also had severe pain which has lead to me getting an ultra sound in my breast. They're extremely uncomfortable and restrict from everyday activities.

Lewis Albert Andres, MD · Answer

Thank you for the question!  There are several steps and criteria that you must meet in order for insurance to authorize breast reduction procedures.  Given that your insurance does not exclude such a procedure, a reasonable time of conservative treatments must be tried and failed.  Symptoms, such as those that you describe, certainly can be attributed to enlarged breasts, and you should discuss such isses with a plastic surgeon to determine if your symptoms match your signs, and begin authorization with insurance.  Many insurances also do require photos and a certain weight to be removed in order to meet insurance criteria.

Given your photos, although difficult to tell without an examination, appear that you would be borderline.  However, a full history and examination by a plastic surgeon would allow him/her to tell you with greater certainty if your case would be deemed reasonable to try to authorize through your insurance.  Hope that this helps!  Good luck!

Gary M. Horndeski, MD · Answer

Insurance
companies authorize breast reductions based on 2 criteria.  One, you must have symptoms such as neck,
back or shoulder pain attributed to large breasts.  Second, you must meet a weight removal criteria
determined by the insurance company.  However,
at size 32 each 100 grams of tissue corresponds to 1 cup size change.  If they require 500 grams removal, you would
go down to a size A and would be dissatisfied. 
Your other alternative is to pay for it yourself.  That way you can achieve the size breasts you
desire without undergoing over reduction to satisfy insurance criteria.  I recommend a new technique called The
Ultimate Breast ReductionTM. 
This technique avoids the ugly vertical scars of the traditional
technique, maintains nipple sensation and the ability to breast feed.  Pain is relieved by transferring the weight
of the breast to the underlying muscle rather than excessive reduction. Best Wishes,Gary Horndeski, M.D.

Miguel Delgado, MD · Answer

It is very possible that you would qualify for breast reduction surgery. It will depend on your insurance policy, each insurance company has their own guidelines. You could contact your insurance company yourself and ask what they require, or see a Board Certified Plastic Surgeon who can help you go through the process. Most insurance companies require that the patient needs to have at least 500 grams of breast tissue removed to qualify. That is usually a cup size DD . Also, it is good to have documented what you have tried to relieve your symptoms of pain, such as physical therapy, analgesics, special fitting bras, etc. Your plastic surgeon will know how to help you apply for coverage. Good luck!

Tom J. Pousti, MD · Answer

Based on your breast cup size and your description of your situation, you may be a good candidate for breast reduction surgery. However, much more information is needed to determine whether you should proceed with surgery, and if so when ( timing).
“Typical” patients who present for breast reduction surgery are women who have disproportionately large breasts, causing problems such as neck/back/shoulder discomfort, postural changes, bra strap grooving, skin irritation/rashes under the breasts, and/or difficulty with activities of daily living and/or exercise etc. There may be both physical as well as psychosocial “stress” caused by the disproportionately large breasts.
Other than the presence of symptoms, the “ideal” patient for breast reduction surgery is one who is psycho socially/emotionally/financially stable, has an excellent social support system surrounding him/her, is capable of arranging enough recovery time, does not smoke and who has reached a long-term stable weight.
Reducing breast tissue mass and elevating the breasts on the chest wall tend to improve or alleviate many of the symptoms associated with the disproportionately large breasts.
Patients considering breast reduction surgery should also consider the potential downsides (risks/complications) associated with the procedure as well. Poor scarring, for example may be associated with the procedure.
When the time is right, I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.
Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.
I hope this, and the attached link, helps.

Matthew H. Steele, MD · Answer

Thank you for your question and photo.  Based on your symptoms and the photo, you would be a great candidate for breast reduction.  Every insurance company is different with regards to coverage of this procedure.  I always dictate a letter and send photographs and an estimate of the weight of breast tissue that I think I can remove.  Sometimes the procedure is denied and the patient will elect to proceed as a cash pay patient.  Detail all of your symptoms with your plastic surgeon and ask them to submit a pre-determination letter to your insurance company to see if it will be covered.  Good luck!

I wear a 32ddd. is there a chance insurance will cover a breast reduction? (photo)

Answers (9)

Answer: I wear a 32ddd. is there a chance insurance will cover a breast reduction?

Answer: I wear a 32ddd. is there a chance insurance will cover a breast reduction?

Answer: Insurance and breast reduction.

Answer: Insurance and breast reduction.

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Everything you need to know about Breast Reduction

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I wear a 32ddd. is there a chance insurance will cover a breast reduction? (photo)

Answers (9)

Answer: I wear a 32ddd. is there a chance insurance will cover a breast reduction?

Answer: I wear a 32ddd. is there a chance insurance will cover a breast reduction?

Answer: Insurance and breast reduction.

Answer: Insurance and breast reduction.

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Recommended reading

Everything you need to know about Breast Reduction

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