Insurance requires 880 grams

It is impossible to give you an accurate answer without examining you or at least seeing some pictures. We try and help our patients understand what different volumes mean using 3D imaging or other ways of simulating the reduction. Looking at pictures of women that look like you and seeing how they look after various size reductions can also help.

Thanks for your question. Your life will improve immeasurably with a reduction. Insurance companies have set arbitrary and ridiculous criteria to avoid covering these. There is no universal method for them to establish a minimum but it is usually based on height and weight. I doubt 880gm is safe if your surgeon said 440gm. Might be worth getting a 2nd opinion. Because a vascularized portion of the breast must be left behind to provide the nipple-areolar complex with blood, there is a limit to what can be resected as you noted in your question. Most of us that do breast cancer reconstructions can pretty well estimate the amount the entire breast weighs. In some cases the insurance company spits out a number that is more than if the entire breast were removed. Although your symptoms are your number 1 reason to have it done, you certainly don't want an amputated breast without shape. Best of Luck!

Agree with Dr. Haydon. This is hopefully a once in a lifetime event. If you desire it covered by an insurance carrier consider switching to a better plan. You may want to consider paying for the surgery yourself so, you can choose the size you desire post op. Many ASAPS members offer package pricing to cover such surgery. Consider looking for one in your area. Best,

Gary Culbertson, MD, FACS

Hello - Hopefully this is a matter of semantics. Perhaps the insurance company is requiring a TOTAL of 880 gram reduction vs. 880 gram reduction per breast? If the latter is the case, you have taken the correct steps to provide a resolution. Another option is to seek out an appeals process. Most insurance companies have this feature. The supporting documentation including consultations from other board certified Plastic surgeons along with your previous back surgery operative reports and current pictures may be enough supporting evidence to have you procedure approved.

Thank you for the question. Insurance companies can vary widely as to their requirement. I would not be surprising that 880 gram per breast could be a requirement. I would suggest that you go back and see your surgeon again. 440 grams is about a box of butter. Your surgeon's office should be able to clarify the requirement. In addition, many insurance companies put their requirement online and you may be able to check for yourself.