Breast reduction surgery, or reduction mammoplasty, isn’t just about aesthetics—it’s a life-changing procedure for people dealing with macromastia or overly large breasts. Excessively large breasts can cause significant physical and emotional problems for women. Having large breasts can cause pain, skin irritation, limit physical activities, and cause poor posture. When breast reduction is done to address these problems, it’s often considered medically necessary, which can mean it will be covered by your insurance provider.
However, getting insurance approval isn’t always straightforward; it calls for the expertise of a skilled plastic surgeon who knows how to work with multiple insurance providers. It’s important to know what insurance companies look for so you can answer the question, “Will insurance cover breast reduction?”
Will Insurance Cover Breast Reduction? Yes: If It’s Medically Necessary
For many women, large breast size goes beyond aesthetic concerns and becomes a health issue. Common symptoms of macromastia include:
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Common Symptoms of Macromastia |
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Category |
Problem |
Description |
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Physical |
Persistent pain from the weight of large breasts can strain your spine and muscles and lead to chronic discomfort. |
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Nerve Compression |
Heavy breast tissue can compress nerves in your neck and shoulders, causing tingling or numbness. |
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Skin Issues |
Friction and trapped moisture under your breast crease can lead to irritation, rashes, and fungal infections like intertrigo. |
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Bra straps may leave painful grooves in your shoulders as they bear the weight of large breasts. |
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Mobility |
Limited Physical Activity |
Heavy breasts can prevent you from enjoying activities like running or exercise due to discomfort or difficulty moving. |
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Breathing Difficulties |
Large breasts can put pressure on your chest, which may make it harder to breathe comfortably during physical activities. |
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Emotional Impact |
Low Self-Esteem |
Physical discomfort and challenges with clothing or social settings may affect your self-image and confidence. |
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Social Anxiety and Isolation |
Some women feel self-conscious or experience unwanted attention, leading them to feel anxiety in social situations. |
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Posture Issues and Self-Perception |
Poor posture, often due to the weight of your breasts, can alter your self-perception and reinforce negative body image feelings. |
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If you are interested in breast reduction surgery to relieve these health issues, it is generally considered a medically necessary procedure. This classification makes it much more likely that insurance will cover breast reduction to improve your physical and emotional well-being.
Understanding Insurance Coverage for Breast Reduction
Even though your breast reduction may be medically necessary, that doesn’t mean insurance will absolutely cover the surgery. Each insurance company has specific criteria for what they consider medically necessary and will cover the costs. That’s why it’s important to work with a plastic surgeon who has support staff with experience in what pre-approvals and documentation you need to help get your breast reduction covered.
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Insurance Requirements To Cover Breast Reduction Surgery |
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Documented Medical Symptoms |
You will need detailed records of your physical symptoms from primary care providers, chiropractors, dermatologists, or physical therapists, plus evidence of your attempted non-surgical treatments. |
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Amount of Breast Tissue to Remove |
Insurance has specific requirements for the amount (in grams) of breast tissue to be removed according to the Schnur Scale. |
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Photographic Evidence |
Pre-operative photos showing breast size and the physical effects of your large (e.g., shoulder grooves from bra straps) may be required and can help solidify your case. |
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Patient History |
To increase your chances of approval, you will need to submit records of previous treatments and their outcomes, highlighting your long-standing symptoms and the lack of relief from other treatments. |
Given the intricacies of obtaining insurance coverage for breast reduction surgery, you need to find a plastic surgeon with the right team in place. Not all surgeons have the expertise or resources to navigate insurance requirements, so look for an office that has these resources.
- Specialized Insurance Coordinators: Top-tier plastic surgeons often work with a dedicated insurance coordinator who understands the unique requirements for coverage from many different providers. These coordinators are invaluable in managing the process efficiently and minimizing any delays, which can make a huge difference not only in securing coverage but also in your experience as a patient.
- Expertise in Insurance Appeals: Even if an insurance company initially denies a claim, a skilled office with experience in negotiating insurance appeals can help you get the decision overturned. Insurance appeals often require additional documentation or detailed explanations, which a knowledgeable team can provide for you or help you collect.
- Personalized Surgical Planning: An expert plastic surgeon will work with each patient individually to understand their symptoms and what they want from their surgery. Find a plastic surgeon who will listen to your needs and wants to help you get the best outcomes from your breast reduction.
Harris Plastic Surgery: Supporting Patients Through the Insurance Process
Navigating the insurance process can feel overwhelming, but having a team around you that understands the process can make everything much more manageable. If you’ve been struggling to answer the question, “Will insurance cover breast reduction?” you’ve come to the right place. Harris Plastic Surgery has both an experienced plastic surgeon (Dr. Stephen Harris) and an expert insurance coordinator (Joanne Parrinello) who work together to bring you a thorough understanding of the paperwork, requirements, and potential roadblocks in navigating your insurance requirements.
Getting your insurance to cover breast reduction surgery can make this procedure accessible even if you can’t afford the surgery outright. By securing coverage, you can finally find relief from chronic pain, regain your mobility, and feel comfortable in your own body. The support and advocacy provided by Harris Plastic Surgery make breast reduction surgery an option for those who need it most.
Harris Plastic Surgery - Your Breast Reconstruction Experts
If you’re wondering, “Will insurance cover breast reduction?” contact us online or by phone/text. You can also schedule your consultation online.
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.
