Insurance requires 880 grams

Several Doctors have suggested a breast reduction for me due to several back surgeries, including spinal fusion; I am currently a 40 G/H cup. I am 51 and always, even a college athlete, 5'8" and 150 pounds had a size DDD cup. Now. In order to get the breast reduction covered, my insurance is demanding a minimum of a 880 gram reduction; my doctor suggested 440g.

Is 880 safe for my blood supply and to prevent nipple loss? I don't want to be OMG you just are small now when I am big boned and a big gal now (228#). I have enough body image issues with loss of ability to do much physically! I would like no more than 3 cup sizes down. PLEASE respond!

Thank you for the question. Insurance companies can vary widely as to their requirement. I would not be surprising that 880 gram per breast could be a requirement. I would suggest that you go back and see your surgeon again. 440 grams is about a box of butter. Your surgeon's office should be able to clarify the requirement. In addition, many insurance companies put their requirement online and you may be able to check for yourself.

Roberta L. Gartside MD
Roberta L. Gartside MD
1800 Town Center PkwyRestonVA20190US

Roberta L. Gartside MD

1800 Town Center Parkway, Suite 412, Reston,
VA, 22090, US

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Hello - Hopefully this is a matter of semantics. Perhaps the insurance company is requiring a TOTAL of 880 gram reduction vs. 880 gram reduction per breast? If the latter is the case, you have taken the correct steps to provide a resolution. Another option is to seek out an appeals process. Most insurance companies have this feature. The supporting documentation including consultations from other board certified Plastic surgeons along with your previous back surgery operative reports and current pictures may be enough supporting evidence to have you procedure approved.

Michael I. Kulick MD
Michael I. Kulick MD
450 Sutter StSFCA94108US

Michael I. Kulick MD

450 Sutter Street, Suite 2620,
San Francisco, CA, 94108, US

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Agree with Dr. Haydon. This is hopefully a once in a lifetime event. If you desire it covered by an insurance carrier consider switching to a better plan. You may want to consider paying for the surgery yourself so, you can choose the size you desire post op. Many ASAPS members offer package pricing to cover such surgery. Consider looking for one in your area. Best,

Gary Culbertson, MD, FACS

Gary R. Culbertson MD, FACS
Gary R. Culbertson MD, FACS
18 Miller RdSumterSC29150US

Gary R. Culbertson MD, FACS

Iris Surgery Center, 18 Miller Road, Sumter,
SC, 29150, US

Thanks for your question. Your life will improve immeasurably with a reduction. Insurance companies have set arbitrary and ridiculous criteria to avoid covering these. There is no universal method for them to establish a minimum but it is usually based on height and weight. I doubt 880gm is safe if your surgeon said 440gm. Might be worth getting a 2nd opinion. Because a vascularized portion of the breast must be left behind to provide the nipple-areolar complex with blood, there is a limit to what can be resected as you noted in your question. Most of us that do breast cancer reconstructions can pretty well estimate the amount the entire breast weighs. In some cases the insurance company spits out a number that is more than if the entire breast were removed. Although your symptoms are your number 1 reason to have it done, you certainly don't want an amputated breast without shape. Best of Luck!

M. Scott Haydon MD
M. Scott Haydon MD
4701 Bee Cave RdAustinTX78746US

M. Scott Haydon MD

4701 Bee Cave Road, Suite 202, Austin, TX,
78746, US

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It is impossible to give you an accurate answer without examining you or at least seeing some pictures. We try and help our patients understand what different volumes mean using 3D imaging or other ways of simulating the reduction. Looking at pictures of women that look like you and seeing how they look after various size reductions can also help.

Clark F Schierle MD, PhD
Clark F Schierle MD, PhD
676 N St Clair StChicagoIL60611US

Clark F Schierle MD, PhD

676 N Saint Clair St #1575, Chicago, IL,
60611, USA

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