Breast reduction surgery, officially called reduction mammoplasty, can relieve the physical and emotional discomfort caused by overly large breasts. However, the financial burden of the surgery deters some from seeking it out, but if you know more about your insurance coverage, you’ll often find this medically necessary is covered or reimbursed in a way that makes improving your health and wellness financially accessible as well.
Breast reduction costs vary based on factors such as insurance coverage, surgical complexity, the plastic surgeon you choose, and your financing options. Streamline your pre-approval process by understanding the specific insurance requirements for breast reduction surgery.
Will Insurance Cover Breast Reduction?
Insurance coverage for breast reduction depends on whether the procedure is deemed medically necessary. Many insurers, including NYSHIP and BCBS, require documented proof of chronic pain, failed conservative treatments, and the amount of tissue to be removed. For instance, NYSHIP uses specific criteria, such as the Schnur Sliding Scale, to evaluate eligibility.
Breast Reduction Costs With & Without Insurance
Understanding the breakdown of costs prior to your procedure can save you time and energy later. When the surgery is covered by insurance, there are limited out-of-pocket costs, like deductibles, copays, and coinsurance. Out-of-network can involve additional expenses but is often reimbursed substantially for those who have good out-of-network coverage. Plus, you’ll have the freedom to do what’s best for your needs – like choose the surgical procedures you prefer and work with a surgeon you trust.
Whether you’re insured through NYSHIP or BCBS, you will need to prove that the surgery is medically necessary in order to get the procedure covered; but working with an office that does these surgeries frequently can make the process easy and straightforward. Proof of necessity can include a medical history of chronic pain, skin conditions, or other health issues directly caused by large breasts.
While the upfront cost may seem daunting, many of our patients get their procedures covered by insurance or have excellent reimbursement rates, and find the long-term benefits of pain relief and improved quality of life well worth the investment!
Breast Reduction Costs With and Without Insurance | ||
---|---|---|
Aspect of Care | With Insurance | Without Insurance |
Surgical Fees | Typically covered if medically necessary | $5,000–$10,000+ depending on surgeon and complexity |
Anesthesia Fees | Often included under insurance coverage | $1,000–$2,000+ |
Facility Fees | Covered if using in-network facilities | $1,500–$4,000 |
Post-Operative Care | Partially covered (depends on policy) | $200–$500 for follow-up appointments and supplies |
Out-of-Network Costs | Patient responsible for the difference between in-network and out-of-network costs | All costs are the patient’s responsibility |
Deductibles and Copays | Varies by plan (e.g., NYSHIP and BCBS deductibles/copays can range from $500–$5,000) | Not applicable |
Medical Necessity Documentation | Required to qualify for insurance coverage (e.g., Schnur Scale compliance, proof of chronic pain) | Not required, but helpful for personal validation |
Financing Options | Rarely needed if fully covered, but an option for copays or out-of-pocket expenses | Many clinics offer payment plans through medical financing |
Pre-Surgery Evaluations | Usually covered under routine diagnostic benefits | $200–$400 per visit |
*The costs listed in this table are for reference only. Your costs will vary based on factors like your location, surgeon, and insurance coverage.
Out-of-Network Options and Bank Financing
Choosing out-of-network coverage for breast reduction surgery can be an excellent option for women seeking specialized care. The best surgeons have extensive experience in breast reduction procedures, and they can ensure personalized attention and improve aesthetic and functional outcomes. Although out-of-network costs may be higher upfront, many insurance plans still provide substantial reimbursement for medically necessary procedures no matter which provider you choose, including only requiring a copay for any aftercare visits you may need.
If your insurance denies coverage, out-of-pocket costs can range from $1,000 to $10,000 or more, depending on the surgeon’s fees, facility charges, and geographic location. But the denial can always be appealed if you and your plastic surgeon evaluate your surgery as medically necessary.
Navigating the Financial Journey
During consultation appointments, we hear patients express concern about breast reduction surgery costs. You can achieve your health and aesthetic goals while getting the best treatment at a reasonable cost. Partner with an office that has a patient care coordinator and insurance liaison to guide you through the process. Whether through insurance, financing, or personal funds, the first step toward a successful surgical journey is understanding your options.
Understanding Leads to Action: Taking the Next Steps
If you’re considering breast reduction, consult a knowledgeable plastic surgeon. Breast reduction specialists like Harris Plastic Surgery provide comprehensive support. From consultation to post-operative care, they’re your trusted partner on your journey to a more comfortable and confident life. Dr. Harris and his team can help you make an informed decision.
Harris Plastic Surgery - Your Breast Reconstruction Experts
If you need help understanding breast reduction costs and navigating your insurance, we are here to help. Schedule your consultation today, or contact us online or by phone/text if you have any additional questions for our team.

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.