Cosmetic Surgery Tips

How to Get Breast Reduction Covered by Kaiser

Breast reduction surgery is one of the most common plastic surgery procedures in the United States. The procedure helps women who are dissatisfied with their breasts to achieve a more proportionate and aesthetically pleasing look. In addition, breast reduction can help alleviate physical pains caused by large breasts including backaches, shoulder pain and neck pain.

The cost of breast reduction surgery can vary from surgeon to surgeon, but it is important to know that there are many factors that affect pricing such as the severity of your case, your location in the country and whether or not your insurance covers the procedure.

In this article, we will look at some of the breast reduction requirements weight and kaiser breast lift cost.

Breast Reduction Surgery Cost Kaiser

Breast Reduction

Breast reduction surgery (reduction mammoplasty) removes some of the tissue and skin from the breasts to reshape and reduce the size of the breasts. It can also make the area of dark skin surrounding the nipple (areola) smaller.

To remove tissue and skin from the breast, the surgeon first makes one or more cuts in the breast. After the excess tissue and skin have been removed, the skin is closed with stitches. Sometimes the nipple and areola have to be removed and repositioned.

Sometimes liposuction is used along with surgery. If most of the breast is fatty tissue and if excess skin isn’t a problem, liposuction alone may be enough for breast reduction.

Breast reduction surgery is done in a hospital or surgical center , typically with general anesthesia . The surgery usually takes 3 to 5 hours. An overnight stay is not usually required. For smaller reductions, the surgery may be done with local anesthesia .

Breast lift (mastopexy) is similar to a breast reduction, except that in some cases only skin is removed. A breast lift can raise sagging or drooping breasts, which is a common problem with large, heavy breasts, and can elevate the nipple and areola.

What To Expect After Surgery

Immediately after surgery, gauze is placed over the incisions, and the breasts are wrapped in an elastic bandage or supported with a special surgical bra. In some cases, there may be a small tube in each breast to help drain blood and fluid for the first couple of days. Stitches may be removed in 1 to 2 weeks.

Most women have some breast pain for the first few days after surgery and then milder discomfort for a week or longer. Medicine can help relieve the pain. Swelling and bruising may last for several weeks. Wearing a surgical bra 24 hours a day can help reduce swelling and support the breasts while they heal.

You will likely resume your normal work and social activities within a couple of weeks, unless those activities involve heavy lifting or strenuous exercise. You may need to avoid more vigorous exercise and activities for 3 to 4 weeks or more. It’s important to wear a bra that supports the breasts well, such as a sports or athletic bra.

You will have visible scars on your breasts after breast reduction surgery. These are almost always in areas that can be covered by a bra or swimsuit. Scars may fade over time, but they will not disappear.

Why It Is Done

Breast reduction surgery is done to change the size, weight, firmness, and shape of the breasts. You may decide to have breast reduction surgery to:

  • Feel more comfortable. Large, heavy breasts can cause back and neck pain, skin irritation, and posture problems. The constant pull of heavy breasts may make bra straps leave painful indentations in a woman’s shoulders. Breast reduction surgery can eliminate these problems in most cases.
  • Reduce the limitations that large, heavy breasts place on participation in sports or other activities. Some physical activities may be painful or awkward for women who have large breasts.
  • Alter your appearance. Large breasts, especially when they are out of proportion to your height and weight, can be embarrassing. Teenagers and young women with large breasts may especially feel self-conscious wearing swimsuits and other types of clothing due to unwelcome attention to large breasts. It also may be hard to find clothes that fit well.

How Well It Works

Women who have breast reduction surgery are often extremely satisfied. It can make the breasts smaller, firmer, lighter, and more evenly proportioned. It usually relieves the physical discomfort and pain caused by large breasts.

The results of breast reduction surgery are considered permanent. But the breasts may become larger or their shape may change as a result of pregnancy, weight gain, or weight loss.


The most common risks of breast reduction surgery include:

  • Scars. Breast reduction surgery always leaves visible scars on the breasts. But how bad the scars are varies from person to person and by the type of incision. Although red and swollen at first, scars typically fade over time. But scars may remain very noticeable in some women long after surgery. Fortunately, the incisions usually can be limited to areas of the breast that can be covered by a bra.
  • Unevenly positioned nipples, or breasts that are not the same size or shape.
  • Loss of feeling in the nipples or breasts. This is often temporary, lasting a few months. But in some women it lasts much longer or becomes permanent. Because some women with large breasts do not have a lot of feeling in their breasts before surgery, this may not be a concern.
  • Inability to breastfeed after surgery. Some women may still be able to breastfeed, depending on what type of reduction was done.

Less commonly, damage to the breast’s blood supply may occur during surgery. This may delay the skin’s healing process. Loss of part or all of the nipple and areola can also occur, but this is not common.

Other risks of surgery include:

  • Excessive bleeding during surgery.
  • Infection.
  • Reaction to the anesthesia.
  • Blood clots in large veins traveling up to the heart and lungs ( pulmonary embolism ). This is not common.

These risks can be serious or even life-threatening, but they rarely occur.

What To Think About

Keep in mind that breast reduction may make breastfeeding difficult or impossible in the future. Some women may still be able to breastfeed after having reduction surgery.

If you are thinking about having a breast reduction, contact your insurance company. Some insurance companies cover some or all of the costs of breast reduction surgery if surgery is being done to relieve back pain, skin problems, or other medical problems caused by large or heavy breasts. They typically will not cover breast reduction surgery being done solely to change the appearance of the breasts, because it is not considered a medically necessary procedure when done for this reason.

When Does Insurance Cover Breast Reduction Surgery?

Key takeaways:

  • Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary.
  • Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary.
  • To get insurance coverage, you’ll probably need documentation of chronic health issues due to breast size.
Photo of a young woman practicing yoga on the beach

Very large breasts — sometimes called macromastia — can cause health problems. The weight of the breasts may lead to pain in the back, shoulder, and neck. Some women have permanent shoulder grooves caused by bra straps or recurrent rashes under the breasts.

Breast reduction surgery — also called reduction mammoplasty — can not only remedy physical symptoms like these but also have psychological benefits. It can improve people’s quality of life, self-esteem, and body image.

If you’re considering a breast reduction, you’re probably wondering how much it costs and whether health insurance covers it. Breast reduction surgery for cosmetic reasons doesn’t qualify for coverage. But if you’re getting the surgery for medical reasons, your health insurance may well cover it. Your insurer has specific rules for how you can get coverage for a breast reduction.

Read on for more details about the cost of breast reduction surgery and when insurance will pay for it.

Is breast reduction covered by health insurance?

It depends. Health insurance only covers breast reduction if it’s considered medically necessary to treat chronic health symptoms.

This means that before you can schedule the breast reduction surgery, you’ll probably have to get insurance authorization. The insurance company will require your surgeon to submit certain health records on your behalf; it will then assess your medical need for the surgery. (Even if your insurance does cover the surgery, you’ll still have to pay copays or deductibles.)

If your breast reduction surgery doesn’t meet your health plan’s medical necessity criteria, it will be considered cosmetic, meaning the insurance company won’t cover it.

How to Get a Breast Reduction Covered by Insurance

Getting approval for breast reduction surgery can be a long, complicated process. Insurers have different criteria for judging the surgery as medically necessary.

Your health insurance plan may require: 

  • A physician’s letter detailing your health symptoms and how long you’ve had them
  • Medical records of previous treatments you’ve tried
  • Your height and weight
  • Photos of your breasts

You’ll generally have to provide records showing that:

  • You have chronic health symptoms caused by having large breasts
  • You have tried other, nonsurgical treatments
  • The nonsurgical treatments have not helped

Some insurers have required a person to be within 20% of their ideal body weight before approving coverage, as weight loss alone can cause the breasts to become smaller. However, given that long-term weight loss is challenging and occasionally unrealistic, some surgeons and academics have questioned this requirement.

Your best bet is to contact your insurer as early as possible, and ask them to list and explain all the requirements and what forms of proof they will accept. That way, you’ll know exactly what documentation to gather and submit.

What makes a breast reduction medically necessary?

A doctor must determine that the surgery is medically necessary. You may need to provide evidence to the doctor and insurer that you’ve already tried nonsurgical treatments — such as physical therapy, weight loss, or musculoskeletal treatments — without success. The insurance company may want proof that you’ve had symptoms for at least 6 months.

Insurance companies may approve breast reduction surgery as medically necessary if:

  • You have severe rashes or skin infections that are hard to treat.
  • Your physical activities are restricted.
  • You have nerve compression due to the weight of the breasts.
  • The weight of your breasts is significantly affecting your posture and spine alignment.
  • Your breasts are painful.
  • You have upper-back, neck, or shoulder pain.
  • You have shoulder grooves from bra straps.

Do breasts have to be a certain size in order for you to be a candidate for reduction?

When it comes to reduction surgery, it’s not exactly a matter of how large your breasts are. The main measure is the amount of tissue to be removed. Your insurance company’s “medically necessary” criteria may require that the procedure remove a certain minimum amount of tissue.

Some insurers use the Schnur Sliding Scale as a reference. This is a ratio that compares the weight of the removed breast tissue with your total body surface area. Although this calculation is a common guideline, it’s not always an absolute rule.

Typically, if your Schnur ratio is above the 22nd percentile, your surgery is considered medically necessary. If it’s below the 5th percentile, it’s considered cosmetic. If your ratio is in between, it may be considered either medical or cosmetic, or a mix of both, and may or may not be approved by insurers.

How much weight is removed in breast reduction? 

The minimum amount varies according to your insurance carrier’s definition. For some, if the amount of breast tissue removed is less than 200 to 350 grams (7 to 12 ounces), the procedure may be considered a breast lift rather than a breast reduction. A breast lift is typically considered cosmetic surgery, and so it is not covered by insurance.

Does Medicare pay for breast reduction?

Not always. Like private insurers, Medicare doesn’t cover cosmetic breast reduction surgery. Both original Medicare and Medicare Advantage will cover the procedure when it is determined to be medically necessary. However, you will probably have to pay for a deductible, copay, or coinsurance.

How much does a breast reduction cost with insurance?

The total cost of breast reduction surgery has several components, including:

  • Surgeon’s fee
  • Anesthesia fees
  • Hospital costs
  • Medical tests
  • Post-surgery garments
  • Prescription medications

The average plastic surgeon’s fee for breast reduction was $5,717 as of 2020, according to the Aesthetic Plastic Surgery National Databank. But fees vary significantly depending on factors like:

  • The surgeon’s level of experience
  • What breast reduction technique the surgeon uses
  • Whether you have the surgery on one or both breasts
  • Market pricing in your geographic location

For example, according to estimates from FAIR Health, here’s a cost breakdown for a patient in Columbus, Ohio, with commercial insurance.

Surgeon’s fee$4,782 ($2,391 per breast)
Anesthesia fee$997
Facility cost for ambulatory surgical center$6,548
Facility cost for hospital outpatient$10,257
Total$12,327 at an ambulatory surgical center
$16,036 at a hospital as an outpatient

Not included: Possible costs such as medical tests, post-operative recovery garments, prescription medications, follow-up treatment, or other fees.

How much does breast reduction surgery cost for the uninsured? 

Without insurance, that patient in Columbus, Ohio, would face costs like this, according to FAIR Health:

Surgeon’s fee$15,870 ($7,935 per breast)
Anesthesia fee$2,151
Facility cost for ambulatory surgical center$16,582
Facility cost for hospital outpatient$20,179
Total$34,603 at an ambulatory surgical center
$38,200 at a hospital as an outpatient

How can I finance a breast reduction?

Numerous plastic surgery providers offer medical financing options, including payment plans. Many accept CareCredit, a healthcare credit card. CareCredit has promotional plans that feature no-interest financing if you pay in full within a given period (6 to 24 months). If you don’t, however, interest charges kick in — potentially at the high annual percentage rate (APR) of 26.99%.

Some online lenders offer loans that can be used to pay for plastic surgery. For example, Prosper Healthcare Lending loans have interest rates ranging from 7.95% to 36.00% APR for up to 60 months.

Of course, you don’t have to use a loan or credit card marketed specifically for healthcare to finance a breast reduction. You can use savings, or shop around to get the lowest-rate loan or credit card available to you. The national average APR on credit cards is less than 15%.

What to expect after breast reduction surgery

After breast reduction surgery, you may need to take a week or two at home to rest and recover. You’ll have some appointments with your plastic surgeon to remove your sutures and get follow-up care. It may be a month or more before you can exercise or do any strenuous activity.

What are the potential complications of breast reduction surgery?

Like any other major surgery, breast reduction surgery has risks. These can include:

  • Bleeding
  • Infection
  • Adverse reaction to anesthesia
  • Bruising
  • Scarring
  • Loss of sensation in the breasts or nipples
  • Difficulty or inability to breastfeed
  • Asymmetric breasts, potentially requiring additional surgery

Even if your incisions heal without mishap, the results might not turn out looking exactly as you envisioned or as your surgeon planned. This is a risk with any type of plastic surgery.

The bottom line

Breast reduction surgery is covered by health insurance when it’s medically necessary. Proving the medical necessity to your insurer can be complicated and may require a lot of documentation from your healthcare provider. Uninsured people, or those who want the reduction for aesthetic reasons, will have to pay for it entirely out of pocket.

Breast Reduction Requirements Weight

Many women notice a reduction in breast size after losing weight through healthy eating and regular exercise.

Kaiser Breast Reduction Surgeons

If you are considering a breast reduction surgery, it is important to choose a skilled and experienced surgeon who can provide you with the best possible results. Kaiser Permanente is a reputable healthcare organization that offers a range of surgical services, including breast reduction procedures. In this article, we will discuss the details of Kaiser breast reduction surgeons, providing you with all the information you need to make an informed decision.

Identifying the Right Surgeon

When it comes to breast reduction surgery, choosing the right surgeon is crucial. Kaiser Permanente has a team of board-certified plastic surgeons who specialize in breast surgeries, including breast reduction. These surgeons have undergone extensive training and have the skills and expertise to perform safe and effective breast reduction procedures.

  • Board-certified plastic surgeons specializing in breast surgeries

  • Extensive training and expertise in breast reduction procedures

What to Expect During the Consultation

During your consultation with a Kaiser breast reduction surgeon, you can expect a thorough evaluation of your breasts and a discussion of your goals and expectations. The surgeon will explain the procedure in detail, including the risks and benefits, and answer any questions you may have. You will also have the opportunity to view before and after photos of previous patients to get an idea of the potential results.

  • Thorough evaluation of breastsDiscussion of goals and expectationsExplanation of procedure, risks, and benefitsViewing before and after photos

Preparing for Surgery

Prior to your breast reduction surgery, your Kaiser surgeon will provide you with specific instructions on how to prepare. This may include guidelines on medications to avoid, eating and drinking restrictions, and arrangements for transportation to and from the surgery center. It is important to follow these instructions carefully to ensure a smooth and successful surgery.

  • Instructions on medication, eating, and drinking restrictionsArrangements for transportation to and from surgery center

Recovering from Surgery

After your breast reduction surgery, it is important to follow your surgeon’s post-operative instructions for a smooth recovery. This may include wearing a surgical bra, avoiding strenuous activities, and attending follow-up appointments. Your Kaiser surgeon will monitor your progress and address any concerns you may have during the recovery process

  • Following post-operative instructions for a smooth recoveryWearing a surgical braAvoiding strenuous activitiesAttending follow-up appointments

Kaiser Breast Lift Cost

When considering a Kaiser breast lift, one of the most important factors to consider is the cost. The cost of a breast lift can vary depending on a number of factors, including the extent of the procedure, the surgeon’s experience, and the location of the clinic. Kaiser Permanente is a popular choice for breast lift surgeries, and understanding the cost associated with these procedures can help you make an informed decision about your care.

Factors Affecting Kaiser Breast Lift Costs

There are several factors that can affect the cost of a Kaiser breast lift, including:

  • The extent of the procedure: The more extensive the surgery, the higher the cost.The surgeon’s experience: More experienced surgeons may charge higher fees.The location of the clinic: Clinics in urban areas tend to have higher fees than those in rural areas.Additional costs: These can include anesthesia fees, facility fees, and post-operative care.

Cost Breakdown

While the exact cost of a Kaiser breast lift will vary depending on these factors, the average cost typically ranges from $5,000 to $10,000. This price usually includes the surgeon’s fees, anesthesia fees, facility fees, and follow-up care. However, it’s important to note that this is just an estimate and your final cost may be higher or lower.

Payment Options

For those considering a Kaiser breast lift, there are several payment options available. These can include:

  1. Payment plans: Some clinics offer financing options to help make the cost more manageable.Insurance coverage: In some cases, a breast lift may be covered by insurance if it is deemed medically necessary. Health savings accounts (HSAs) or flexible spending accounts (FSAs): These accounts can be used to cover the cost of a breast lift.

Results from a breast lift typically last between 10 and 15 years, but some patients can go much longer without needing a revision.

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