American Society of Plastic Surgeons
For Medical Professionals
 
Kimberly
3 years ago
Answered

Insurance Coverage

I’m 49 my bra size is 38 G. I have AVN in the right shoulder and will soon need it replaced. Quick Surgery List 2003 total Radical Hysterectomy with a double oophorectory no HRT until 2012 Osteoporosis diagnosis. 2008-2014 three lower lumbar L5 S1 disc surgeries, 2015 total right hip Arthroplasty. 2012 began weight gain due to mobility issues. Am I a candidate?

Procedure: Breast Reduction

Replies 6

Gregory Baum
ASPS Surgeon

You are probably a good candidate but an in-person consultation would be needed to really say for sure. The insurance companies will want to know your height and weight among other things in an effort to determine if your procedure is “medically necessary”. I always submit photos along with a letter of medical necessity to the insurance carriers. It usually takes 2-3 weeks to hear back from the insurance carriers and you get acipyifthe same letter that I get regarding approval/denial of the procedure. I hope this helps. Best wishes!

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Sandra Bouzaglou
ASPS Surgeon

Absolutely! In a heartbeat!

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Mark Boschert
ASPS Surgeon

Yes, sure, you sound like a good candidate. You should see a PS in your area and they can write a letter to insurance to get the process started. Best of Luck! Dr. Boschert

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Jonathan Zelken
ASPS Surgeon
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Kim, you seem like a great candidate. But, let's not forget why you have osteoporosis and osteopenia. You need to make sure your hormones are optimized before any surgical procedure is considered. If you've had oophorectomy, the replacement hormones can increase your risk of complications like blood clots. On the surface, you seem like a great candidate for surgery. We just have to make sure you are surgically optimized!

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Jon Ver Halen
ASPS Surgeon
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Dear Kimberly,

Hello and thank you for your excellent question. It sounds as though you may be a great candidate for a breast reduction. It is essential that you have an in-person consultation to develop a treatment plan that specifically addresses your personal surgical goals, and your body’s anatomy. 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. It may take some effort to find a surgeon who accepts your insurance for this procedure, as it is often times not covered. If you have any questions, call our office for assistance. Good luck!

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Mark Deutsch
ASPS Surgeon

Kimberly,

You sound like you are a good candidate for a breast reduction and I feel this will help with your back and neck discomfort. It is best that you get a referral to a board certified plastic surgeon who is on your insurance plan and it may be necessary to also have documentation from a physical therapist or a chiropractor that you have tried non-surgical therapy. Regardless, I feel you will be tremendously happy after a breast reduction. Good luck!

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