Breast reduction

How likely is it that I will qualify for a breast reduction covered by insurance? I am 18 years old, so obviously I cannot afford to pay for surgery out of pocket. I have had large breasts for years, I was around a B cup by the time I reached 5th grade. I am now 5 foot 4 1/2 inches, weigh 150 pounds, and have a bra size of 34DDD. I have tried losing weight, but my breasts stay the same size. Even when I was 130 pounds. I already have lumbar lordosis, so my back is already in pain. My shoulders and neck hurt constantly. I really need my insurance to cover it. I have Blue Cross Blue Shield of Massachusetts.

Insurance coverage for breast reduction is based on whether your surgeon can remove a minimum amount of tissue/weight. If you meet this, insurance will cover it but you still have your co-pays and deductibles so it may still cost more than you think. You could have a cosmetic reduction for around $6500 in my neighborhood if your out of pocket expenses exceed that... but it may not count towards your deductible since it was done cosmetically. Best to see a contracted Plastic Surgeon for an evaluation and determination if your situation will quality. Realize that this procedure WILL impact your ability to breast feed AND that its likely you will lose sensation to your nipples in addition to the scarring that you must accept. So it is not an easy decision when you are as young as you are.

Curtis S. F. Wong, MD
Curtis S. F. Wong, MD
1950 Rosaline AveReddingCA96001US

Curtis S. F. Wong, MD

1950 Rosaline Ave, Redding, CA,
UNITED STATES, 96001

Thank you for asking. This is a very common condition with a very high patient satisfaction rate. You may need a referral to a plastic surgeon from your primary doctor. Each insurance is different but criteria and documentation to support a breast reduction should be in place. Seeing a board certified plastic surgeon will help confirm your situation and set you up for an appropriate procedure. Best wishes!

David C. Yao, MD, FACS
David C. Yao, MD, FACS
5010 E Shea BlvdPhoenixAZ85028US

David C. Yao, MD, FACS

5010 E Shea Blvd, #175, Scottsdale, AZ,
UNITED STATES, 85254

Thank you for your question and for doing your homework with ASAPS member surgeons. Each insurance company will have slightly different criteria for breast reduction coverage. The best course of action is to have an in-person consultation with a board-certified plastic surgeon in your area. Together you and your surgeon can develop a treatment plan that is best suited to your individual body, breast reduction goals, and timeline. The ASAPS website has a "Find a Surgeon" feature that can assist you in locating a qualified surgeon in your area. Best wishes on a great result and speedy recovery.

Trent D. Douglas, MD
Trent D. Douglas, MD
8899 University Center LnSan DiegoCA92122US

Trent D. Douglas, MD

8899 University Center Ln, #200, San Diego,
CA, UNITED STATES, 92122