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

Question

I think I am a cup size D (102 cm in circumference). I have been suffering from lower and upper back aches, a sharp pain at the base of my neck, and hard time breathing every morning I wake up. For years, I've had pus-filled cysts and skin infections under my saggy breasts that can never go away no matter how many topical creams I try or soaps I wash with. If I talk with my physician, would these symptoms get me documented and approved for a breast reduction to a comfortable B cup (or somewhere near 70 cm)?

James N. Romanelli, MD, FACS · Answer

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

Scott C. Lindsay, DO · Answer

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!

Gary M. Horndeski, MD · Answer

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.

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

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Everything you need to know about Breast Reduction

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

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

Answers (3)

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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.