When someone mentions breast reduction weight requirements, the reference is typically in regards to insurance companies. That is, plastic surgeons do not commonly have breast reduction surgery weight requirements.
Most anyone can get the surgery as long as they qualify in terms of overall health (no serious ongoing medical conditions, non-smoking status, etc.) and can afford the surgery out-of-pocket, with medical credit, or with a credit card.
It is health insurance companies that (frequently) require a certain BMI in order to provide coverage for breast reduction surgery. The process of uncovering what specific requirements your particular health insurance company has can sometimes be a challenge, however.
If you are considering a breast reduction and would like to see if you qualify for insurance coverage, read on to learn more.
Does Health Insurance Cover Breast Reduction?
Yes, health insurance plans do sometimes provide coverage for breast reduction surgery. Here’s why:
Breast reduction surgery aims to reduce a woman’s breast size by excising excess skin, breast tissue, and fat. Most reduction surgeries also include a breast lift.
Women may seek surgery for a number of reasons. But unlike most motivations for breast augmentation, for example, most patients who are motivated to undergo surgery do so for more physical and emotional reasons.
The truth is, having excessively large breasts can cause a number of serious problems, including but not limited to:
- Shoulder pain
- Back pain
- Neck pain
- Bra-related rashes
- Rashes beneath the breasts
- Difficulty exercising and moving in general
- Self-consciousness and embarrassment
These issues can often be fully corrected with breast reductions. And with the excess skin, fat, and breast tissue removed, patients are frequently able to return to more comfortable and contented lives.
What Are the Insurance Requirements for Breast Reduction Surgery?
When it comes to health insurance companies, among most of their breast reduction requirements weight is usually the one talked about the most. And here is where things get somewhat sticky.
For starters, it is not possible to report to you all of the weight requirements stipulated by health insurance companies. This is because each company has different requirements, and each plan has different requirements.
What we can tell you is that most insurance providers simply want to know that a patient’s BMI (body mass index) is not too high when they are seeking breast reduction surgery.
This is because — sometimes — if a patient has excessively large breasts and is also overweight or obese, the actual cause of their large breasts may be weight-related. And if that patient were to lose weight, their breast size related issues may improve, meaning that the breast reduction procedure (and subsequent coverage) would not technically be “medically necessary”.
This is why many insurance companies will say that a patient must have a body mass index BMI of less than 30, less than 35, or less than another set number. Sometimes, a provider will use the Schnur Sliding Scale, which measures total body surface area against how much breast tissue needs to be removed.
In other cases, the candidate for breast reduction will simply need verification that the patient tried and was unsuccessful at losing weight (if they were overweight or obese in the first place).
Additional Breast Reduction Requirements
Keep in mind that other requirements may be in place for breast reduction surgery coverage as well:
Proof Patient Sought Medical Help
Often, insurance providers want to know that a patient truly has physical problems related to the size of their breasts. They may want proof that the patient has sought physical therapy, did not recently gain weight, and sought other aid in reducing the severity of their physical symptoms.
Proof Large Breasts Are the Core Issue
Insurance companies also want to rule out other issues, which may be causing medical symptoms such as back pain. They may want the patient to get tests to confirm that they don’t have another medical condition such as diabetes, breast cancer, or something else.
Proof Breast Reduction Surgery Will Actually Help
Finally, insurance companies want to know that if the patient does achieve a healthy breast size with breast reduction surgery, that their symptoms and ailments will improve.
After all, if surgery won’t actually correct the problems that the patient is facing, insurance providers won’t want to provide coverage for an aesthetics-only procedure.
FAQ: Breast Reduction Surgery
How much is breast reduction?
Breast reduction cost ranges can vary drastically. Each patient has their own unique goals and may or may not want additional procedures performed. If you are concerned about the price of breast reduction surgery, please book a consultation with Dr. Mohan to learn more about the cost breakdown.
Is breast reduction covered by insurance if I’m overweight?
This depends. Some insurance providers have a certain BMI limit while others simply want to know that you tried to lose weight in the past with diet and exercise or weight loss surgery.
Is there a minimum breast size for a reduction?
Breast reduction eligibility isn’t solely based on size, but typically, surgeons suggest at least a C cup. Individual proportions and preferences vary.
Call Today to Book an Initial Consultation
Understanding breast reduction weight requirements for insurance can be especially difficult for many patients. If you are seeking breast reduction surgery and are concerned about weighing too much to qualify for coverage, please give our office a call and schedule a consultation appointment with board certified plastic surgeon Dr. Raja Mohan.
At your appointment, you can look at breast reduction before and after photos alongside Dr. Mohan, talk about your ultimate goals, discuss breast reduction recovery, and ask any questions you may have. Please contact us today to book your appointment!
References
https://www.plasticsurgery.org/news/blog/is-breast-reduction-covered-by-health-insurance