Woman holding lower back and grimacing in pain, considering breast reduction surgery

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Will my breast reduction surgery be covered?

If you feel like the size of your breasts is interfering with your quality of life, I encourage you to consult with a plastic surgeon certified by the American Board of Plastic Surgery. Use this visit to learn about your options for breast reduction surgery. Being a good candidate for breast reduction surgery means you have a thorough understanding of your symptoms and what the surgery can do for you.

If you are considering breast reduction surgery here are some things to keep in mind to determine if the procedure will be covered by your insurance plan:

Read your insurance policy thoroughly.

If your insurer does not provide coverage for breast reduction, you might not be covered for a plastic surgery consultation either. However, most insurance plans will consider your documented symptoms, the duration of symptoms, and how your symptoms may affect your quality of life.

Discuss your concerns with your primary care provider.

Letters from your primary care physician, chiropractor and/or physical therapist can be valuable to building your case for prior authorization for a breast reduction. This documentation, when included in a packet with a letter and pictures from your plastic surgeon may help you obtain authorization from your insurer prior to scheduling surgery. This is a necessary step, as an insurance plan may refuse to cover the costs associated with breast reduction surgery if it’s not pre-authorized.

Understand how your insurance plan determines medical necessity.

It is common for insurance companies to require that a certain amount of breast tissue be removed for your breast reduction to be considered medically necessary. The breast tissue amount to be removed is based on your height and weight. This requirement may conflict with your aesthetic goals, so be informed and prepared.

If you disagree with your insurance carrier's decision, you are entitled to an appeal.

Breast reduction is one of the most patient pleasing procedures I perform as a plastic surgeon. Working together, my colleagues and I want to help you make decisions that are right for you. That’s why I encourage you to schedule a consultation with a board-certified plastic surgeon if you want to know more.

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