How to See If My Breast Reduction Is Covered by Insurance


woman holding her back

Commonly referred to as breast reduction surgery, mammaplasty is a surgical procedure whereby a cosmetic surgeon removes excess fat, tissue, and skin to reduce a patient’s overall breast size. This type of surgery is ideal for individuals with large breasts and can benefit from breast reduction surgery, not only to resolve discomfort but also to achieve a breast size that is in proportion with the rest of the body. Also, mammoplasty can improve a woman’s self-confidence along with their physical health. In this article, we will take a closer look at what this procedure entails and the process involved in having it covered by health insurance.

Who Should Consider Breast Reduction Surgery

Although resolving pain and achieving a more proportionate breast size are the main reasons why most women opt to undergo mammoplasty, there are several other factors including

  • Nerve pain
  • Ill-fitting bras and other clothing
  • An inability to engage in certain activities
  • Skin irritation underneath the breast
  • Neck, back, and shoulder pain

Is Breast Reduction Surgery Safe?

While all surgical procedures are inherently risky, mammoplasty is generally safe with most complications stemming from an undesirable reaction to anesthesia, bleeding, and infection at the incision site. That said, breast reduction surgery may not be a good fit for all women endowed with large breast. Young women under the age of 16, for example, are encouraged to avoid undergoing the procedure as their breast are usually not fully developed. Additional factors that can rule out breast reduction surgery include

  • Smoking
  • Not wanting scars on your breasts
  • Obesity
  • Diabetes

Heart disease and cardiovascular disease
In discussing safety, it is also worth noting that breast reduction surgery is not recommended for women who are trying to conceive in that breastfeeding can be difficult following surgery.

Will Losing Weight Result In Smaller Breast?

Women who are actively trying to lose weight are also encouraged to postpone the procedure since losing weight can indirectly contribute to smaller breast size. Breasts are mainly made up of fat tissue, and as fat cells expand, they become larger. Conversely, as these cells shrink, they become smaller. So as you lose weight, you will notice an appreciable reduction in the size of your breasts, especially if you’re naturally predisposed to storing a lot of fatty tissue in the breast region.

It is important to note that the extent to which breast become smaller as a result of losing weight can vary. Some women, for example, have breasts that are comprised of less fatty tissue, meaning they will experience a less noticeable reduction in breast size as they lose weight. Genetics also plays a role in the amount of fat tissue stored in the breasts, not to mention their size as you gain or lose weight. The best way to gauge how much smaller your breast will become as a result of losing weight is by scheduling a consultation with your prospective surgeon. In most cases, he or she will recommend that you lose weight prior to surgery and will advise you on how much smaller your breast will become after losing the weight.

What to Expect During Surgery

As you would probably expect, breast reduction surgery is almost always done under general anesthesia and performed in an outpatient facility or hospital. During the procedure, the surgeon will use one of two methods to remove excess fat and reduce the overall size of the patient’s breast, surgical incision or liposuction. The surgeon will also make an incision around the areola, which is the pigmented ring surrounding the nipple, and down the length of each breast before removing fat, tissue, and skin, which, in effect, reduces the overall size of the breast. Lastly, the breasts are reshaped before the areola is repositioned on the newly resized breast. Lastly, the breasts are reshaped, and the areola is repositioned to match the new size of the breasts.

Is Breast Reconstruction Covered By Health Insurance?

Generally speaking, breast reconstruction surgery is only covered by insurance if the procedure is deemed medically necessary, but everything is not always black-and-white. Breast reduction surgery will generally be construed as a cosmetic procedure unless the patient can prove that they have an underlying health condition that can only be remediated by undergoing the corrective procedure. Breast reduction surgery will generally be construed as a cosmetic procedure unless the patient can prove that they have an underlying health condition that can only be remediated by undergoing the corrective procedure. Also, patients will have to meet a predetermined insurance threshold before the surgery can be covered by their insurance policy.

How To Get Insurance To Cover Your Breast Reconstruction Surgery

While the process can vary depending on the insurance provider, patients interested in having breast reconstruction surgery covered by their insurance will typically have to furnish their insurance provider with a letter of medical necessity, which states that procedure is required in order to resolve an underlying health problem. Beyond that, most insurance providers will request 6 to 12 months of documentation, along with treatment by a physical therapist, chiropractor, dermatologist, or orthopedist, to ensure other treatments have been ruled out before approving surgery.

The best way to speed up the approval process with your health insurance provider is by requesting a letter stating what is required for approval from your insurance provider well in advance of breast reconstruction surgery. This is important since the criteria for approval is different for each insurance company. After submitting the necessary documentation, the average turnaround time can be anywhere from 3 to 6 months.

This time frame allows the insurance provider to confer with the treating physician and also seek second opinions from other healthcare providers like chiropractors, for example, to confirm the surgery is medically necessary. Ideally, it is a good idea to inform that your physician of your intent to have the procedure covered under insurance, which helps to ensure that letters of medical necessity and other documents are promptly sent to your insurance provider.

How Much Is Breast Reduction Surgery Without Insurance?

Although the process of getting breast reduction surgery covered by insurance can be challenging, it can save you a considerable amount of money, provided your claim is approved. According to data compiled by the American Society of Plastic Surgeons, the average cost of a breast reduction surgery is $5,482, which includes the following additional fees:

  • Facility costs
  • Anesthesia
  • Surgeon fees
  • Post-surgery prescription medications

Medical tests

Obviously, the cost of breast reduction surgery can be cost-prohibitive for some people; however, it is important to note that some cosmetic surgeons do offer financing plans that can make paying for a much-needed surgery more manageable. That said, if having the procedure covered by insurance is not an option, it may be a good idea to speak with your physician about possible financing options. For more information, please contact Scot Bradley Glasberg, MD at 212-717-8550.

More to explorer