American Society of Plastic Surgeons
For Medical Professionals
4 years ago

Debating if I Should Do It or Not

Hi, I am 21 years old with bra size that is 38D. I am 5'2" and weighs 118 pound. I have messaged my insurance company and they said that breast reduction is covered through authorization from my providers. Will I be okay to do the reduction if my provider authorized it? And is it possible for my provider to decline authorization for me doing breast reduction? Thank you.

Procedure: Breast Reduction
Location: Brooklyn Park, MN

Replies 6

Karol Gutowski
ASPS Surgeon

Your insurance may say they cover it and may issue a "Prior Authorization" but the final determination of payment is usually made after the surgery. This is an issue between you and your insurance company.

Nelson Castillo

Thank you for sharing your excellent question. The best advice is to be seen for an in-person evaluation by an ASPS specialist performing the reduction. They can offer you the best treatment advice and the likelihood of having the insurance company pay for the procedure despite their promises that it is a covered expense, since they have various loopholes that will need to be met by your surgeon. Hope this helps.

Matthew Camp
ASPS Surgeon

Authorization is up to the insurance company. It is then up to your provider to agree to perform the surgery for you, after performing a thorough examination.

M Scott Haydon
ASPS Surgeon
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Thanks for your question. Breast reduction approval is extremely frustrating. Each insurance company has different arbitrary criterion. As your plastic surgeon, my job is to evaluate you and based on your symptoms, correlate your physical exam to the problems you are having (neck pain, shoulder pain, etc.). An experienced surgeon can fairly accurately estimate the amount of breast tissue that can safely be removed without compromising blood flow to the nipple areolar complex. This information is submitted for preauthorization. Insurance carriers have customer service representatives that are instructed to tell the policy holders if a procedure is "covered". They don't publish what percentage are not approved. In our experience only about 20% get approved and these are normally extremely large breasts. It unfairly penalizes someone like you with breasts that are clearly disproportionately large for your frame which is a healthy height/weight. Best of Luck!

Lori Cherup
ASPS Surgeon

Brooklyn: First, unless you are very wide, it's almost impossible for you to be petite, 5'2" 110lbs and have a 38" chest. I bet your bra is very poorly sized. Second, according to most insurance charts at your height and weight roughly 350G of tissue needs to be removed from each breast. 350 G of tissue from a D cup breast would absolutely leave you at a B cup. Will that help you? The ONLY WAY you can know if your insurance will pay for your surgery is to see a good plastic surgeon who does many reductions, and have that person examine you. Never trust your insurance company.

Bahram Ghaderi
ASPS Surgeon

Hello and thank you for your question.

I would recommend meeting with a board certified plastic surgeon to be evaluated and see if you meet criteria for insurance coverage. There are many factors that go into the authorization for the procedure. Meeting with a reputable plastic surgeon should help you to understand the process better and get the information you need. Best of luck.


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