American Society of Plastic Surgeons
For Medical Professionals
 
Kay123456
one year ago
Answered

Breast Reduction

I have scoliosis and chronic back pain. My breast is a size 34DD or 34DDD depending on where I get my bra from. Is it possible for me to get my insurance to cover breast reduction surgery? Also, twice this year I started to get rash under my breast due to the size and I am currently using prescribed anti-fungal medication to assist with the rash. I live in Florida.

Thank you

Procedure: Breast Reduction
Location: Lakeland, FL

Replies 5

Douglas Monasebian
ASPS Surgeon
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Good day and thank you for your question. Dr. Monasebian, our Board Certified Plastic Surgeon, will be able to address your concerns. Insurance coverage is usually based on medical necessity and policy terms. You certainly seem to have medical conditions which may be improved by breast reduction. The best course of action is to see a surgeon and then you both can inquire from your insurance carrier if breast reduction is a covered benefit. We would be happy to see you if you are in the New York City area. We look forward to meeting you soon.

Regards, Dr. Monasebian and Park Avenue Plastic Surgery.

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Daniel Allan

Breast reduction is covered by insurance if you meet the criteria of th insurance company, which vary from one carrier to another. You will need to consult a plastic surgeon and his/her office will request prior authorization.

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Nelson Castillo

Thank you for sharing your question. I would first contact your insurance carrier to see if a breast reduction is a covered expense. If it is, then schedule consultations with board certified plastic surgeons to get a sense as to how much weight would need to be removed in order to satisfy your insurance company's restrictions. A predetermination letter can then be sent to see if you qualify. Hope this helps.

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Lori Cherup
ASPS Surgeon

You live in the wrong state or have the wrong health insurance. Most insurance companies in Pennsylvania would cover your breast reduction if 350-450 G of tissue were removed from each breast, IF YOU ARE OF NORMAL HEIGHT AND WEIGHT, ie. 5'5" and less than 145 lbs. 30% of plastic surgeons in Pennsylvania accept insurance from other states. Our practice does. Most Florida plastic surgeons want to practice only cosmetic surgery. There is help if you look wider than your local town.

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Michelle Copeland
ASPS Surgeon
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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. Large breasts may not only interfere with your physical ability to function in daily activities but can be emotionally burdensome as well. From what you describe you are a candidate for a breast reduction It is possible to do a breast reduction with a minimal scar technique and can also be done as an outpatient procedure under twilight sedation. Make sure that you understand the nature of your surgery, the recovery process, and that you feel comfortable and emotionally ready to make these changes to your body. I suggest you make an appointment with a board certified plastic surgeon who will examine you and go over your surgical options in detail.

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