Breast Reduction is a Medical Necessity Most of the Time

Breast reduction surgery is often mistakenly grouped with breast lift procedures and frequently discussed as if it were a purely cosmetic procedure. But for many individuals, getting breast reduction surgery is far from a choice based on aesthetics alone. While a breast lift focuses on reshaping and elevating the breasts without necessarily reducing their size dramatically, breast reduction is about alleviating serious medical symptoms caused by overly large breasts.

These physical and emotional symptoms can severely impact a woman’s daily life and lead to additional health complications over time. The misconception about this procedure is particularly problematic because it leads to underestimating breast reduction medical necessity, making it harder for those who truly need it to gain insurance approval and support. Breast reduction addresses both functional and health-related issues, and it is time for this procedure to be recognized as the medically necessary intervention it is.

How Do You Determine Breast Reduction Medical Necessity?

A breast reduction may be deemed medically necessary when it’s performed to alleviate symptoms related to macromastia. Macromastia is a condition where you have excessively large breasts that create a disproportionate strain on your body. The extra weight from large breasts can result in long-term physical symptoms. The following table highlights some of the common symptoms that could make breast reduction medically necessary.

When a woman wants breast reduction surgery to alleviate these symptoms, it’s generally considered medically necessary. As a result, many health insurance plans will cover the procedure — provided you submit the right documentation. That’s why it’s so important to work with a plastic surgeon who has the right support team in place to help you navigate the requirements of your specific insurance provider.

Cosmetic vs. Medically Necessary Breast Reduction

While breast reduction is often a medical necessity, there are instances where it’s considered a cosmetic procedure. Cosmetic breast reduction focuses on improving the appearance of the breasts rather than alleviating specific medical issues. For example:

• Minor Size Reductions: When women only want a small reduction for aesthetic reasons, it is typically considered a cosmetic procedure.
• Absence of Medical Symptoms: Women who do not experience chronic pain, skin irritation, or mobility restrictions related to breast size may be considered cosmetic candidates.
• Elective Adjustments: In some cases, a woman may wish to refine the shape, contour, or symmetry of her breasts, which is generally regarded as an elective cosmetic modification.

In cases where breast reduction is elective or purely for aesthetic reasons, insurance companies typically do not cover the procedure, and women may need to pay out of pocket.

However, just because a breast lift is considered a cosmetic procedure doesn’t mean it lacks personal significance or impact. For many women, a breast lift can restore their confidence, enhance their body image, and provide a sense of renewed self-esteem after changes due to aging, weight fluctuations, or pregnancy. 

While a cosmetic breast reduction or breast lift may not address physical health symptoms like a medically necessary breast reduction, the procedure can have a positive effect on your mental health and improve your overall quality of life. At Harris Plastic Surgery, we believe all women deserve to have a body they love, whether it’s called medically necessary by insurance companies or not.

Harris Plastic Surgery Understands Your Need for Medically Necessary Breast Reduction

At Harris Plastic Surgery, we are proud to be the best choice for breast reduction because of our expertise, unwavering commitment to patient care, and comprehensive, personalized treatment approaches. Dr. Harris is a skilled plastic surgeon experienced not only in the medical necessity of breast reduction procedures but also in understanding the aesthetic outcomes that matter most to our patients. During consultations, we take the time to evaluate each individual’s unique needs, creating tailored surgical plans to help achieve optimal results suited to your unique body.

We also have a dedicated patient care coordinator and insurance liaison in Joanne Parrinello. Joanne is here to simplify the often complex insurance approval process, ensuring that our patients can easily access the care they need and are entitled to. We prioritize both the physical and emotional well-being of our patients, helping to alleviate the pain and discomfort associated with overly large breasts while empowering them to embrace their bodies with confidence.

Choosing Harris Plastic Surgery means choosing a supportive partner in your health and body transformation journey.