Weight Loss Requirement For Breast Reduction?

Question

I've read a lot of the info. here but no one mentioned anything about having to lose weight before having a breast reduction. I called a PS and was asked about my height and weight and was told I needed to lose weight before the insurance would pay. Is there a weight restriction/requirement before the insurance carrier will pay for the BR?

Michael Orseck, MD · Answer

Every insurance company has their own criteria regarding idal wieght for a breast reduction. You can actually contact your insurance carrier for the specific details. If you need help with that, your PS insurance specialist should be able to help you.

Steven Wallach, MD · Answer

Each insurance carrier has different criteria for approval of breast reduction surgery. I suggest that you contact your insurance company and find out what they require.

Robert L. Kraft, MD, FACS · Answer

Many insurance companies use a body mass index (BMI) in calculating whether to cover breast reductions on the assumption that, if you are overweight, then the breast size is attributable to obesity which should be treated with a weight loss regimen rather than surgery. Insurers are more likely to apply these criteria in patients with DD-DDD breasts than in those with gigantomastia in which the resection would be greater than 1000 grams per breast.   Most of us who perform breast reduction regularly have staff members who are knowledgeable about the insurance requirements, which vary by the company and are subject to change.

Tom J. Pousti, MD · Answer

Thank you for your question.  

	You will find that every insurance has a different "policy" in regards to the weight of the patient.  It is in your best interest to be at your lowest, stable weight prior to any type of breast surgery. Being at your lowest weight prior to surgery will reduce the chance that you need for additional surgery.

	Breast Reduction is one of the most patient pleasing operations that we do.

	Best Wishes.

Mary Lee Peters, MD (retired) · Answer

Women with a very high BMI often have extremely large breasts. The large breasts cause discomfort and make it difficult to exercise and burn calories. Although breast reduction can be done under those circumstances,the surgery proceeds more smoothly if one is not obese. Obesity increases the rate of wound infections, disruption of suture lines and tissue loss. Every 10 lbs of weight loss increases safety of your breast reduction. It is not necessary to get all the way to your ideal body weight. The prospect of surgery can motivate you to achieve a healthier life style. This promotes needed personal change at the same time as external change occurs. More of a win-win situation.

Alan M. Engler, MD, FACS (retired) · Answer

In general, insurance companies are more likely to consider a breast reduction as a "covered" procedure if your Body Surface Area (BSA) or Body Mass Index (BMI) are within a certain range, and that's probably what your PS was referring to.  If you are too heavy for your frame, according to a scale such as one of these, then the insurance company will want you to lose weight and bring you down into their acceptable range before proceeding.  Your PS was probably just trying to save you the trouble of coming in and delivering the news at that point.

	The exact requirements of each company are different and you should call your own company and find out both what their criteria are for breast reduction and to get a list of participating surgeons.  It may make sense to start with them and, hopefully, to find one of them that you're comfortable with.

	I hope that this helps and good luck,

	Dr. E

Weight Loss Requirement For Breast Reduction?

Answers (6)

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