Would I be approved for a breast reduction?

It sounds as though you may be a good candidate for a breast reduction. Large heavy breasts, neck and shoulder strain, shoulder strap grooving, rashes under the breasts and inability to do certain activities such as work out, running, etc. are all symptoms related to large, heavy breasts. Many of these symptoms can be improved and some even alleviated by a breast reduction. It is best to try to lose as much weight as you feel you can prior to the procedure because excessive weight loss after the surgery may prompt the need to revise the procedure. You will also get a better and better long-term result with preoperative weight loss.

Whether your insurance carrier will pay for it is another story. While the procedure may be "medically necessary" as determined by your surgeon, most insurance carriers require strict criteria to be met including a specific weight amount of tissue that has to be removed, the need for other therapies (physical therapy, weight loss, medical therapies, etc.) before they will even consider coverage for this procedure. It has been my experience that while most insurance companies say "it's covered" that really means it is a coverable expense and is not a guarantee of payment. Many times, they refuse payment even after they say "it's covered". You should make sure that your insurance carrier will pay for the procedure before you do it because if they refuse payment after the procedure has been done, you could be left with a very large surgeon's and hospital bill.

Many surgeon's now refuse to accept insurance payment for this procedure because of all of the above requirements. We have found that when you compare the surgeon's fees (surgeon, anesthesia and facility fees) paying for this out-of-pocket to your copayment and deductible using insurance, many times it costs you LESS if you pay for this by yourself and do not involve the insurance carrier. Sad...but true.

As plastic surgeon, we can discuss your issues and tell you the risk and whether or not you are a candidate for the procedure. Approval from your insurance company depends on your coverage. It is not uncommon for breast reduction to not be included in the list of benefits, so whether you are a candidate or not from a medical necessity view point, the procedure will not be approved. You may first wish to check with your insurance carrier about that. The second issue you raise is also an important one, being overweight increases you risks of post operative complications. Losing weight first may not necessarily make your breasts smaller, but would be beneficial for your overall health. You should talk with a board certified plastic surgeon to help you understand all your issues.

Insurance companies over the years have become much more restrictive on approving breast reduction surgery. Many policies exclude it entirely but each policy will have its own unique criteria that must be met prior to the insurance company authorizing surgery. The best way to determine if your particular insurance policy will approve you for breast reduction surgery is to see a plastic surgeon who accepts your type of insurance and have a consultation. At that time an examination can be performed and details of the surgery can be discussed with you. The plastic surgeon will then need to submit a letter to your insurance company stating the reasons that you need to have surgery. They will then evaluate the information sent to them and make a decision based on their company policies. If your insurance approves the surgery, you may proceed. If not, you have the option of having the reduction surgery done as a cosmetic/self-pay patient. Often hospitals and anesthesiologists will offer discounts to patients who pay for their surgery prior to the procedure.

For the best results seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. They have a website listing all the certified plastic surgeons. Members of the American Society of Aesthetic Plastic Surgery will all be board certified in plastic surgery and have demonstrated an interest and competence in cosmetic plastic surgery as well.

Your best bet is to schedule an appointment to see a board certified plastic surgeon who can evaluate your symptoms, size, symmetry, and goals and put all of this information together to give you a realistic sense of how likely you are to meet the criteria of your particular insurance carrier. At our practice we use a combination of direct measurements, 3D imaging measurements, and online tools to try and predict this.