I want to know if I qualify for a breast reduction?

I have neck pain, lower back pain and also get rashes underneath my breasts in the summer. I am a 40 DDD. Do I qualify for a breast reduction?

With our present health care system your insurance plan will dictate what is considered as a covered service such as a breast reduction. Consider giving your insurance plan call to see if Breast Reductions are a covered service and what criteria they require for you have the procedure performed. Some insurance plans do not cover this type of surgery.

Best,

Gary R 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

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Thank you for the question. Many women with large heavy breasts have the same symptoms you do. A consultation with a plastic surgeon will provide you with the information about the procedure and the risks and benefits. Although you may be a excellent candidate for the surgery, insurance coverage is another issue. First, I would recommend that you contact your insurer or have your Human Resources department help you to find out if there is the benefit under your particular policy for the procedure. There are some companies that will have an exclusion and even though you have "medically" qualify there is no coverage for the procedure. If you have coverage, you plastic surgeon's office may be able to assist you authorizing the procedure after your consultation.

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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Medically speaking it sounds like you qualify for a breast reduction, provided you are otherwise in good health and do not smoke. For those with significant health problems, smokers, or other issues which may affect your ability to tolerate surgery or heal well, you may need to improve your health prior to this procedure. However, this does NOT mean that your insurance company will agree with this assessment. Insurance companies require a certain amount if tissue to be removed based on your height and weight, a certain BMI (within a range of weight for your height), and documentation of your symptoms by your physician, as well as any treatments you have tried to alleviate your symptoms. The more documentation that you have, the better chance you have of approval.

Roxanne Sylora MD, FACS
Roxanne Sylora MD, FACS
400 Celebration PlCelebrationFL34747US

Roxanne Sylora MD, FACS

Suite A320, 400 Celebration Place,
Celebration, FL, 34747, US

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You have many of the criteria most insurance companies look for but many will require you to see if the back pain responds to a course of physical therapy first. Others require the surgeon to remove a certain minimum volume of tissue ( anywhere from 350 grams to 500 grams) and others will base the decision of how much needs to be removed to qualify based on your BMI (body mass index as worked out by Dr. Paul Schnur a plastic surgeon who published this study some years ago to make it fair for women of different weight and sizes). See a board certified Plastic Surgeon in your area and bring your current insurance carrier information with you so that a pre authorization can be done for you.

Peter P. Kay MD, FACS
Peter P. Kay MD, FACS
2355 N Wyatt DrTucsonAZ85712US

Peter P. Kay MD, FACS

2355 N. Wyatt Drive, Suite 111,Tucson, AZ,
85712, US