American Society of Plastic Surgeons
For Medical Professionals
9 months ago

Will insurance cover this procedure?

I’m 5’3, 145 lbs, and a size 34DDD/34F and am wondering if based on my proportions would my insurance be likely to cover a breast reduction surgery.

Procedure: Breast Reduction
Type: Question

Replies 5

Aaron Stone
ASPS Surgeon

Whether or not it would be covered depends on your insurance policy. Most require a medical record documented specific period of attempted non-surgical treatment such as chiropractic or physical therapy for pain or topical medications for breast related rashes and an amount of tissue to be removed proportional to your height and weight. Your surgeon will have to submit a letter for preauthorization to your insurance company to get approval for coverage before proceeding with surgery. It would be best if your surgeon has a copy of the health insurance policy before writing the letter to make sure each criteria of coverage is addressed in the letter and documented in you medical record.

James Chappell
ASPS Surgeon

Your specific insurance policy dictates the terms of coverage and a competent surgical scheduler in an experienced board certified plastic surgeon’s office can work with you to help establish if you will get it covered. Of course you can call the insurance company and they can tell you too. Assuming you will have a minimum of about 1.1 or more pounds removed per breast and have relevant symptoms that you have reported to your primary doctor (and possibly have had physical therapy or chiropractic care) you may get the surgery covered.

Jon Sattler
ASPS Surgeon

Ms. dejah22, You sound like a person who might benefit from a breast reduction. All the insurance companies treat the patients differently. Your best bet is to contact your insurance company and see if they will cover your surgery and anesthesia in an outpatient facility or hospital.

Edward Domanskis

Based on what you have written your insurance should cover a breast reduction but every policy is different. We take photos and submit them to your carrier and see if we can get pre-approval.

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

Newport Beach

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

Nelson Castillo
ASPS Surgeon

It is possible, but only an in-person examination can offer the best advice. With that not only can the amount of anticipated tissue to be removed be known, but examining your insurance plan for coverage can also be entertained.


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