Medicare- how many grams to remove?

There are many criteria that medicare and insurance companies use to pay for a breast reduction. The usual is about 500grams or aboutr one pound from each breast but again this is not a fixed figure.

Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery

Newport Beach, San Francisco,Miami, EU, Anguilla

Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine)

Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors

Plastic Surgery- 2005-2018

President,American Society of Bariatric Plastic Surgeons

Organoderm Skin care/ScaRxTape

Thank you for sharing your question. The amount of breast tissue needed to be removed will vary based on insurance company as well as BSA calculations. It can be in the 300-700 gram per breast range for most patients. Set up a consultation with an ASPS board certified plastic surgeon to assess your candidacy and submit a claim. Best wishes.

For required reduction amounts most insurance companies still use the Schnur Scale as a guideline. Based on your height and weight, that would be 404g. However, there are many other criteria which need to be satisfied besides weight removed. These include other medical symptoms and treatments prior to breast reduction, often for up to a year.

Consult with a Board Certified Plastic Surgeon and make sure they ask you detailed questions about your specific insurance policy (not just insurance company) and the symptoms and treatments you have had to see if pursuing insurance coverage is indicated.

Breast reduction helps so many women, even those with reductions below the Schnur scale numbers, but policies, coverage, and criteria vary widely.

Every insurance company has their own criteria but most use the Schnur scale which is based on body surface area ( based on height and weight). Medicare unfortunately does not do pre-approval (unless it is a combined HMO) and thus you do not want to be borderline. The surgeon can only guess as no one knows the density of your breast. I recommend to patients if they want only a smaller amount removed they should pay for it on their own, outside of the hospital, thus guaranteeing costs will be lower than a hospital and other bills that are denied by insurance. The Schnur scale recommends about 400 grams. I would recommend 450 grams (15 ounces) to be on the safe side. That would be roughly a can and a half soda cans of tissue removed from each side. Less than that would be considered not enough to alleviate symptoms and thus, cosmetic in nature or a small reduction or mastopexy. If you do not want that much removed consider a self pay small reduction or breast lift to control costs.