American Society of Plastic Surgeons
For Medical Professionals
5 years ago

How old do you have to be and will insurance cover it?

My breast hurt my back etc

Procedure: Breast Lift
Location: Annapoils, MD

Replies 7

Shashidhar Kusuma
ASPS Surgeon

The usual age for what I believe you are asking about, a breast reduction due to size of the breasts and hence the back and neck pain, is after puberty. That age is about 16 to 18 or so, but is case dependent. The insurance process is very cumbersome and problematic and usually is based on a history of conservative treatment, weight loss, therapy etc. Even then it is based on a formula based on height, weight, presence of rashes, failure of other management etc., that doesn't suit every situation.

So, yes, in some cases insurance covers it and in many others it doesn't.

Steven Wallach
ASPS Surgeon
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If you desire a breast reduction, I usually wait until the patient has reached adult size. This can be around 15 or 16. Sometimes patients may be younger if they suffer from gigantomastia.

Tracy McCall
ASPS Surgeon

Call the nurse at your primary care doctor's office. Tell the nurse your problem, including your age and your bra size. They should be able to help you with a referral to a board certified plastic surgeon, or to a physical therapist or other practitioner if that is more appropriate. Sometimes your insurance requires that you have failed non-surgical methods before they will cover surgery.

Kelly Sullivan
ASPS Surgeon

If you are having trouble with back, neck or shoulder pain from large breasts that hang down far on your chest, then a breast lift with reduction can probably help you feel better. It is a good idea to wait to have surgery until your breasts have stopped growing. Every situation is different but our office can help you determine if this surgery is right for you and if insurance will help cover the costs. We would be happy to meet with you and give you more detailed information.

Jack Peterson
ASPS Surgeon

I like a patient to have completed development, so usually at least 16 or older. Some insurance will cover a breast reduction if you meet the criteria of that particular insurance company ( I have seen several that require 18) . In addition, they are usually going to want documentation of medical issues due to large breasts that can include back, neck, shoulder pain, headaches, limitation of activity, strap mark and shoulder grooving, rashes and/or lesions under the breasts.

Best to check with your specific carrier and your specific policy to see if a breast reduction is covered.

Best of luck

Jack Peterson MD

Anne Taylor
ASPS Surgeon

Hello and thanks for the excellent question. I would recommend that you are sure you are finished developing-- which for most young ladies is around 16-17 years old. For the insurance to cover this, you just need to meet the usual requirements for amount of tissue removed, and have documented other medical problems caused by the large size of your breasts, such as neck pain and rashes.

Breast Wishes!

Jon Ver Halen

Dear Chanelle,

Hello and thank you for your excellent question. You should first call your insurance company to see if 1) breast reduction is covered by your plan, and 2) under what conditions. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!


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