American Society of Plastic Surgeons
For Medical Professionals
3 years ago

Tummy tuck and breast reduction

Any chance insurance would cover documented breast reduction AND removing extra mid-lower tummy skin that hangs from pregnancy? It's been 35 years.

Procedure: Breast Augmentation
Location: Fergus Falls, MN

Replies 4

Debra Johnson
ASPS Surgeon
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Breast reduction is usually a covered benefit, but you'd have to check with your health plan's customer service to make sure. If covered, the woman would need to have disproportionately large breasts (DD or greater) with symptoms of neck, back, and shoulder pain that is unrelieved by conservative treatments (special bras, over-the-counter pain medication, massage, diet and exercise, chiropractic care, etc). Some plans like Kaiser require you to be within 25% of your ideal body weight. As far as abdominoplasty is concerned, it is rarely covered except in those patients who have undergone massive weight loss (greater than 100 pounds) and have symptoms such as skin infections or ulceration. If your loose skin is the result of a pregnancy 35 years ago, and you have no other symptoms, correction would be considered cosmetic and would be on your own dime. Sorry.

Nelson Castillo

Thank you for your question. Unfortunately a stomach procedure like a tummy tuck is deemed aesthetic and will not be covered by insurance.

Matthew Camp
ASPS Surgeon

Insurance generally covers breast reduction for relief of back/neck pain and difficulty with recurrent rashes under the breast. Depending on how large your belly tissue is, tummy tuck MAY be covered. If you have so much excess that you have rashes and infections in the belly fold, insurance will cover it as a medical tummy tuck, known as a "panniculectomy". There are requirements for documentation of infections prior to seeing the surgeon. If you do develop an infection or rash, see your primary care doctor for treatment. Their documentation is often a requirement for consideration for surgery. Many plastic surgeons do not accept insurance, so make sure to ask their office if they accept insurance prior to booking an appointment. Best Wishes!

Timothy Mountcastle
ASPS Surgeon

Breast reduction can be covered by most Insurances. A letter of medical necessity from your Pcp and removing anywhere from 500 grams or more depending on insurance type. Panniculectomy are only covered with evidence of bleeding or ongoing infection and it’s still uphill from there with most insurances.


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