Breast Reduction and Lift Covered by Insurance

Breast Reduction and Lift Covered by Insurance

Breast reduction and breast lift are two procedures with the goal of improving the appearance of a woman’s breasts. While both procedures can involve the removal of tissue, and both enhance the quality of life, the procedures’ techniques,  goals, and outcomes are different. The differences between procedures also explain why insurance often covers breast reduction but not breast lift. Let’s find out more.

Differences Between Breast Reduction and Breast Lift

While breast reduction and breast lift have visually similar outcomes, the reasons for getting each surgery and the surgical techniques are different.

Differences Between Breast Reduction and Breast Lift

 

Breast Reduction

Breast Lift

Also Called

Reduction Mammaplasty

Mastopexy

Goal

Alleviate the physical discomfort and limited mobility caused by large breasts.

Raise and reshape the breasts after breastfeeding or aging to provide an uplifted and youthful appearance.

Surgery

Excess breast tissue, fat, and skin are removed using well-placed, easily hidden incisions around the nipple-areolar complex and lower pole of the breast.

Excess skin is removed, and the breast tissue is lifted and reshaped to be aesthetically pleasing. The nipple-areolar complex may be repositioned higher to match the new breast mound position.

Covered By Insurance

If Medically Necessary

Not Usually (unless it is a symmetry procedure matching a breast reconstruction on the other side)

In some instances, a breast lift can also be completed at the time of a breast reduction surgery for a better functional and aesthetic outcome. Deciding which procedure is best for you depends on your reasons for the surgery and your anatomy. Consulting with an expert plastic surgeon can help you make the right decision for your lifestyle and surgical goals.

Are Breast Reduction and Lift Covered By Insurance?

Breast reduction is often covered by insurance if the procedure is deemed medically necessary, whereas breast lift is considered a cosmetic procedure and typically not covered by insurance. Even though insurance doesn’t qualify breast lift as a medically necessary procedure, that doesn’t mean the surgery would not be life-changing for you and is worth the out-of-pocket expenses to get you back into a body you love.

For a breast reduction to be considered medically necessary, you must meet specific criteria and have documentation of unsuccessfully trying to fix the problems you experience through other means.

What Makes Breast Reduction Medically Necessary?

Chronic Pain

Chronic pain in your neck, back, or shoulders due to the weight of your breasts that doesn’t resolve with exercise or better-fitting clothing. 

Skin Conditions

Certain skin conditions like intertrigo (red, inflamed, and itchy rashes that can break open and lead to infections) in the skin folds under the breast.

Shoulder Gooving

Shoulder grooving is caused by bra straps continuously pulling down on the skin and putting pressure on the muscles of your shoulders, and isn’t fixed with a better-fitting bra. 

Schnur Scale

A measurement calculator used to determine if the amount of tissue planned to be removed from your breasts meets specific minimum qualifications.

Meeting these criteria doesn’t guarantee that your insurance will cover the procedure; that’s why it’s essential to work with a plastic surgeon who has a dedicated staff member to help you get the most from your coverage and coordinate with your insurance provider for any preauthorization documentation. Insurance can be confusing, but with an excellent insurance liaison through your plastic surgeon’s office, the entire process can be much smoother and less stressful.

Harris Plastic Surgery — Your Breast Reduction and Lift Experts

If you are thinking about rejuvenating your breasts but aren’t sure whether a breast reduction or breast lift is best for you. Or, if you have more questions about potentially getting a breast reduction and lift covered by insurance, call or text the experts at Harris Plastic Surgery to schedule your consultation and find out your options.

Joanne Parrinello, Practice Manager

Joanne Parrinello is an expert patient care coordinator, with two decades of experience navigating the complex financial side of medically necessary breast reduction and reconstruction surgery. She acts as a guide to patients, helping them understand their options and their expected out-of-pocket expense. The insurance industry can be complex and filled with jargon that makes you feel like you need a translator. At Harris Plastic Surgery, Joanne is that translator.

Let's have a conversation about you

CATEGORIES

Request a Consultation