American Society of Plastic Surgeons
For Medical Professionals
5 years ago

What is the necessary amount of breast tissue for ins to aporive?

I saw a surgeon & sadly, he was brief and answered few questions. I am small frame, 5'5" & 155 lbs. I am a 36DDD The Dr. said 250 grams is what he would remove from each breast: not asking me about size I wanted, etc.; Replacement Medicare plan said I need a letter of medical necessity from the surgeon. He said a letter from my pain mgmt Dr. would help. What is your opinion?Is my criteria enough?

Procedure: Breast Reduction
Location: Lenexa, KS

Replies 3

Trent Douglas
ASPS Surgeon
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Thank you for your question and doing your homework with ASPS member surgeons. Insurance coverage for breast reduction will vary from plan to plan. It is very common for a company to request patient photographs as well as medical documentation of other treatments that have been tried prior to surgery such as weight loss, chiropractic treatments, or dermatology treatments for skin conditions associated with large breast size. Most insurance providers use the Schnurr scale that helps individualize the amount of breast tissue that must be removed to be covered. This scale accounts for different body size and proportions. It is always best to see a board-certified plastic surgeon in your area and together you can develop a treatment plan that is best suited to your individual proportions and insurance coverage. Best wishes on a great result and speedy recovery.

Jon Ver Halen

Dear Pamelyn,

Hello and thank you for your excellent question. 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!

Susan Buenaventura
ASPS Surgeon
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Hello Pamelyn, you sound like a good candidate for breast reduction. The amount of tissue to be removed safely is usually about half the weight of the breast. All insurance companies vary as to whether they will cover a breast reduction, and if they will, all their criteria and policies are different. Perhaps seek another consultation with someone who will spend more time with you. The surgeon can help you navigate your insurance company's policies and whether coverage is possible. Best wishes to you!


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