American Society of Plastic Surgeons
For Medical Professionals
 
CinPenmanship
2 years ago
Answered

Will this qualify me for Breast reduction Surgery?

I wear a 36H bra. My last MRI was May 2019 which I only recently got the results from because my doctor was kicked off my insurance. The findings say: MILD LEVOSCOLIOSIS, LUMBAR SPINE. MINIMAL POSTERIOR BULGING DISC ANNULI, L3-4 AND L4-5, WITH BILATERAL FACET ARTHROPATHY, SLIGHTLY GREATER AT THE LOWER LEVEL. THERE IS MILD MIDLINE THECAL SAC DEFORMITY AT BOTH LEVELS. MINIMAL POSTERIOR BULGING DISC

Procedure: Breast Reduction
Location: Forest Hills, NY

Replies 10

Mark Albert
ASPS Surgeon

Hello,

Thank you for your question. Your MRI indicates that you have a bulging disc (mild) and some spinal joint diseasee. I wouldn't be able to predict whether this would be able to get your breast reduction covered by iteself. I would need to know more about your symptoms and why the MRI was ordered in the first place. Based on the information you have provided, you seem to be a very good candidate to have a breast reduction covered by insurance. I would set up a virtual consultation with a surgeon with you to discuss your symptoms and review the context of your MRI. Thank you.

Mark G. Albert, M.D.

New York, NY

More
 Show more Replies  Replies 1 less
Sukhbir Singh

hi

thanks for your query. as I can see from your mri reports u have mainly spine problems and I do not know why was MRI ordered for u, if u could clarify that. rest would suggest an online virtual consult with board certified plastic surgeon and resolve your query.

More
 Show more Replies  Replies 1 less
Douglas Monasebian
ASPS Surgeon
Add to Favorites

Good day and thank you for your question. Dr. Monasebian, our Board Certified Plastic Surgeon, will be able to address your concerns. He would have to see you in person to review your history and perform an examination. You may very well be a candidate for breast reduction surgery. We would be happy to see you if you are in the New York City area. Medical insurance may help cover the costs of the procedure if deemed medically necessary which can be determined at your consultation. We look forward to meeting you soon.

Regards, Dr. Monasebian and Park Avenue Plastic Surgery.

More
Steven Wallach
ASPS Surgeon

An MRI is helpful but symptoms such as neck and back pain along with bra strap grooving are symptoms that patients with symptomatic macromastia(large breasts) often have. You are best to be seen in person to be properly evaluated.

More
 Show more Replies  Replies 1 less
George Lefkovits
ASPS Surgeon

While your bra size is, indeed, quite large and you appear to have MRI deformities of your spine, you did not mention any symptoms caused by your breast enlargement. You really need to consult with a Board Certified plastic surgeon who can then help to see whether you would be a good candidate for a breast reduction and to see whether your insurance would cover the procedure. Good luck!

More
John Layliev
ASPS Surgeon
Add to Favorites

Hi! Thanks for your question. It sounds like there may be other reasons that could be causing your back pain. You should seek care from a neurologist/spine surgeon to evaluate your MRI results. With regards to your breasts, insurance coverage for breast reductions typically take into account your height and weight and determine an amount of breast grams needed to be removed during a breast reduction in order for your surgery to be considered "medically necessary." This varies a bit depending on the type of health insurance you have. When you consult a board certified plastic surgeon, you'll find out if you are a good candidate for a breast reduction given the requirements and your body habitus. Best of luck!

More
Samara Churgin
ASPS Surgeon
Add to Favorites

Hello. To best answer your question as to whether you qualify for a breast reduction, an in person consultation would be the best to guide you along in this process. As a female plastic surgeon that performs many breast reductions, I can tell you that a number of factors weigh into the insurance company’s decision to cover a surgery such as this. We would need to discuss your symptoms, any treatment that you underwent and why had the MRI done to begin with. Lumbar back disease neither qualifies or disqualifies you for breast reduction surgery. Feel free to contact me if you would like to learn more about breast reduction surgery and insurance coverage. My staff and I specialize in helping guide patients through the process.

Dr. Samara Churgin

Manhattan, New York

More
Nelson Castillo

Thank you for sharing your question. Although the MRI results may strengthen your case, most insurance companies want to see failure of conservative, medical type treatments before approving surgery. This typically involves "failed" physical therapy sessions and weight loss (does not improve symptoms), as well as need for prescription medications, recommendations by a back surgeon, etc. I would seek out a series of in-person consultation when available to assess your candidacy and further identify the items you need to do to place yourself in the best situation for coverage.

More
Michelle Copeland
ASPS Surgeon
Add to Favorites

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.

More
Logo

Patient Care Center