Breast Reduction

Is it likely that insurance would cover a breast reduction? I'm 5'4, 42F, and 229 lbs. I've been wanting one for years but I don’t think I have any significant physical problems that would consider it 'medically necessary', but my new insurance looks like it would cover it if I removed enough grams.

Thank you for your question! Breast reduction is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine, which sounds like your situation. Recently, managed care has adopted stricter standards for coverage, so make sure these problems are thoroughly documented in writing by your primary care physician and plastic surgeon. They may also have to submit photographs. Even then, you may be required to seek a second opinion from a chiropractor, physical therapist, or orthopedic surgeon. Large breasts may not only interfere with your physical ability to function in daily activities but can be emotionally burdensome as well. Breast reduction surgery removes excess breast tissue and reshapes the contour of the breasts so that they are smaller and perkier. I suggest you make an appointment with a board-certified plastic surgeon who can go over your options in detail.

Michelle Copeland, MD, FACS
Michelle Copeland, MD, FACS
1001 5th AveNew YorkNY10028US

Michelle Copeland, MD, FACS

1001 5th Ave, New York, NY, UNITED STATES,
10028

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Yes. Most insurance companies will cover reduction if the patient has shoulder, upper back and neck pain, cup size DD or larger, and if a substantial amount of breast tissue is estimated to be removed. The estimated removal would be determined by your plastic surgeon during your in-person consultation.

Your situation raises another question: timing of surgery vs. weight loss. Breast reduction would make it easier for you to be active, which should help you lose weight. The weigh loss may make the breast more loose or relaxed. On the other hand, your plastic surgeon could give you the best breast if you lost excess weight prior to the reduction surgery. Discuss this with your surgeon.

Sutton L. Graham, II., MD, FACS
Sutton L. Graham, II., MD, FACS
615 Halton RdGreenvilleSC29607US

Sutton L. Graham, II., MD, FACS

615 Halton Rd, #100, Greenville, SC,
UNITED STATES, 29607

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