205lb, 5'3, 24 y/o: Would my Insurance Approve my Documentation for Reduction?

Hello,I'm sorry to hear you are have been experiencing some back aches and sharp pains. All the symptoms you listed show that you would be a candidate for a breast reduction. In addition, any documentation of physical therapy or chiropractor appointments would also help. I hope that helps.Best of luck,Dr. Luck

It's difficult to determine if you would be approved or not for a reduction. The best thing you can do is try. Speak with your insurance carrier to determine if a breast reduction is a covered benefit and if there are certain surgeons you need to see for an evaluation. Then set up a consultation to discuss your symptoms and to begin the process.

Dear Passionate30759

Your symptoms really support breast reduction as a medically necessary procedure, and documentation by your primary care physician generally helps with obtaining insurance coverage.

In our practice, about 80% of patients who come for breast reduction have their procedure covered by insurance. See a board certified plastic surgeon to explore further. Attached, some information on breast reductions overall, as well as insurance coverage.

Best of Luck,
Dr. Romanelli

Thank you for your question.
Schedule a consultation with a board certified plastic surgeon for an evaluation. He or she will send in the necessary documentation to your insurance company for approval. Best wishes!

At 5'3 and 205 lbs., your BMI is 36, which puts you at a high risk for surgery. Also, if you are only a size D then it is unlikely that insurance will cover a breast reduction. What you have described is mostly saggy breasts, which is never covered by insurance. Unfortunately, you have not provided photographs. However, the technique I recommend is a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief and long term stability. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This technique is not covered by insurance.

Best Wishes,

Gary Horndeski, M.D.