Large breasts can be more than a mere cosmetic concern for some women. The extra weight of the breasts can strain back and shoulder muscles and cause painful chafing in the breast creases. Those who suffer symptoms may be diagnosed with symptomatic macromastia, a condition that can be surgically treated. Insurance coverage is often available for breast reduction surgery (reduction mammoplasty) as long as specific criteria are met.
What is Breast Reduction Surgery?
A breast reduction is a cosmetic surgical procedure that removes excess tissue from the breasts to reduce breast volume and the overall size of the breasts. Board-certified plastic surgeon Dr. Kahlil Andrews specializes in customized procedures according to each patient’s unique anatomy and treatment goals and uses advanced surgical techniques to ensure safety and exceptional results. By reducing breast weight and giving the breasts a more balanced appearance with the body, most patients feel more confident and can enjoy relief from chronic pain and breast limitations associated with their overly large breasts.
Symptoms of Macromastia (Breast Hypertrophy)
Macromastia or overly large breasts is a condition that can cause women to suffer from one or more of the following:
- Shoulder, back and neck pain
- Bra strap rashes/infections or grooving in the shoulder
- Skin irritation caused by chafing or moisture of the skin under the breasts
- Numbness in the hands or fingers
- Difficulty fitting into bras or clothing
- Difficulty working out because of excessively large breasts
These physical symptoms can greatly impact women’s overall quality of life, leading many to consult with their primary physicians or seek chiropractic care, physical therapy, and pain medications for relief. The good news is that patients who have documented symptoms as a result of their large breasts often meet the criteria for insurance coverage.
Qualifying for Insurance Coverage
Many patients feel overwhelmed by breast reduction costs. However, many insurance companies cover reduction mammoplasty procedures when patients have a documented history of any of the above symptoms. However, other criteria may also need to be met by the patient and surgeon to determine whether the procedure is considered medically necessary. These criteria include:
Body Mass Index Restrictions
Some health insurance plans will not cover the procedure for patients with a BMI greater than 30 or 35, since the higher BMI may indicate weight loss could help to improve the symptoms.
Weight of Breast Tissue
While the weight of the breast tissue provides indications of breast size; it does not offer information about the relationship between breast size and a woman’s body size. Some insurance companies may use a formula to make this correlation to determine whether the breasts are large enough to warrant surgical treatment relative to a patient’s body surface area (“Schnur Sliding Scale”).
Physician Letter
This letter usually comes from a primary care physician or other provider that has treated a patient’s symptoms associated with breast size in the past.
Photographs and Other Documentation
Photos of the breasts and specific measurements that show breast size in relation to body size may also be required by some insurance companies.
Schedule a Consultation
While the criteria can be extensive, a plastic surgeon specializing in breast procedures can help a patient determine whether they meet the common criteria for insurance for breast reduction surgery. To learn more about breast reduction, or insurance coverage options for the procedure, contact Dr. Andrews Plastic, Cosmetic & Reconstructive Surgery at 319-220-4644.
