Cosmetic Surgery Tips

Cost Of Breast Reduction Surgery Without Insurance

Breast reduction surgery costs between $5,000 and $10,000. If you have health insurance, the cost of breast reduction surgery will be covered by your insurance company. If you do not have health insurance, you can expect to pay between $5,000 and $10,000 out-of-pocket for your breast reduction surgery.

In most cases, the cost of breast reduction surgery without insurance is comparable to other plastic surgeries such as a tummy tuck or rhinoplasty (nose job).

For example, if you are looking at having a breast reduction without health insurance, the average cost would be around $5,000 – 10,000 in total. This cost includes the surgeon’s fee (which varies depending on where you live), anesthesia costs (if needed), and any other fees associated with the procedure itself (such as hospital fees).

Cost Of Breast Reduction Surgery Without Insurance

How To Pay for your Breast Reduction

Breast reductions are unlike most cosmetic procedures in that they often can be justified as medically necessary. That is, there are real physical symptoms including pain, headaches, rashes, numbness, and tingling that can be relieved by this procedure, also called a reduction mammaplasty. This makes for some very happy patients: not only do they feel a whole lot better afterward, they can also finally find tops that fit.

For many women, this makes the procedure well worth saving up for. But the cost–about $9,000–is not pocket change. That’s because a lot goes into that, including:

  • Hospital or facility fees
  • Anesthesia fees
  • Surgeon’s fees
  • Lab and other testing fees
  • Prescription medications
  • Special garments for after surgery

The good news is there are several options when it comes to paying for your breast reduction.

Insurance Coverage

Whenever a treatment like a breast reduction is deemed medically necessary, there is the potential that insurance will cover it. That is the case for some of the patients we see here in North Texas. But, getting it covered is not always as straightforward as it sounds. It is important that you look closely at your particular insurance policy. Policies vary widely and can even change year to year.

If you think you might be a candidate for insurance coverage, first look closely at your policy, go online, and even call your carrier. If they cover breast reductions, make sure you understand their requirements.

  • There may be paperwork that needs to be filed even before your first visit with a plastic surgeon. Many carriers want a paper trail of failed non-surgical treatments for specific complaints. For instance: pain medications or muscle relaxers were prescribed without helping; prescription anti-fungal creams for rashes were unsuccessful; physical therapy or chiropractic care failed to relieve neck pain; or weight loss didn’t change symptoms. It can also be helpful to provide letters from other physicians such as your primary care provider, pain doctor, or ob-gyn, saying that they feel you would benefit from breast reduction.
  • You may be required to first consult with an orthopaedic surgeon or undergo weeks of physical therapy treatment.
  • You may only qualify for coverage if a certain amount of breast tissue needs to be removed. This is called the Schnur scale and is based on a patient’s height and weight. It is simply a chart that states the weight of tissue that needs to be removed (relative to a your height and weight) to be considered a reduction and not a breast lift.

Watch out for policy exclusions on breast reductions. This means that your carrier will not cover breast reductions, no matter the reason, even if your doctor says it is medically necessary. It is also important to note that the combination of a high deductible and copayment requirements, sometimes make it less expensive to pay outside of your insurance.

Non-Insurance Options

The majority of our patients pay for their breast reductions without insurance. The cost can vary depending on each case, but Dr. Slack provides all preoperative and postoperative visits at no additional cost. This usually includes about five visits. Here are the most common ways our patients pay:

Credit: Many of our patients pay by credit card. This can be attractive because of various incentive and points programs available. Watch out for high interest rates, though. You may even be able to take advantage of an introductory offer and pay no interest at all.

Cash or check: In this increasingly paperless society, you may be glad to know that we do still accept cash and checks. Start saving. You’ll be surprised at how quickly you’ll have enough for something that’s important to you, if you pay yourself instead of Starbucks. Better yet, quit smoking (which you need to do before surgery anyway) and you’ll save a bundle.

Medical Financing: Companies like Prosper and CareCredit® offer convenient monthly payment options exclusively for healthcare services. They often have no upfront costs and no prepayment penalties, which means you can get the surgery you want sooner than later.

Whichever way you choose to pay for your breast reduction, it is important to remember that cost is not the only (or most important) factor to consider. The value of a qualified plastic surgeon you can trust, and who gives you the care you need, should not be underestimated.

Does insurance cover breast reduction

I recently saw a female college student as a new patient consultation in my office concerning possible breast reduction surgery. This procedure, also known as reduction mammaplasty, is indicated for the treatment of symptomatic macromastia (large breasts). The commonly reported symptoms related to macromastia are neck, shoulder and back pain caused by the weight of overly large breasts upon the musculoskeletal system. Other secondary symptoms can include breast pain and dermatitis or rashes beneath the breasts.

The college student was referred to me by her gynecologist and arrived with a prescription recommending a consultation with a plastic surgeon due to her condition. The patient was under the common impression that because she was referred to me by another physician, that the suggested surgery would automatically be covered by her health insurance plan. She came in hoping that the breast reduction surgery could be scheduled in four weeks, during her winter break from college.

After completing a patient history and regional breast examination, my staff discussed with her what would be needed to obtain insurance authorization for her surgery.

As it turned out, this patient had no other medical treatment or previous consultations concerning her macromastia. She also had no history of being referred for physical therapy, chiropractic treatment, an orthopedic consultation or a dermatology exam. For many procedures, this lack of treatment history might not be an issue. But for breast reduction, which can be considered cosmetic or reconstructive, depending on the patient – and the insurance company reviewer – the lack of history for this patient would prove problematic.

Unfortunately, the patient had not completed all of the regimens that her insurance required for the reduction procedure to be covered in her case. She will be able to reapply for reduction mammoplasty coverage after the requirements have been completed, but, unfortunately, there is still no guarantee that her insurance will cover the procedure. Naturally, as a college student, she was not in the position to consider paying out-of-pocket for the procedure and was not happy to discover the insurance hurdles she would need to go through for potential coverage.

This story is just an example of why it’s so important for patients to do their homework regarding their insurance coverage for any surgical procedure before seeing a surgeon. The answer to “is breast reduction surgery covered by health insurance?” can be very complicated and involve many variables.

Breast reduction and health insurance

It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure.

In the case of breast reduction, however, for insurance purposes, it will typically be considered a cosmetic procedure until the patient can prove an adequate number of health issues and attempted remediations of those issues prior to undergoing corrective surgery. Once the threshold has been reached, the insurance company may then consider breast reduction a reconstructive procedure for that patient and cover it. The problem is that the threshold can be different for every insurance company or insurance company reviewer. It is my opinion that breast reduction surgery has long been thought of as a “hybrid” procedure. It is considered reconstructive in attempts to obtain insurance coverage for the surgery, but it is also considered cosmetic in that patients expect meticulous aesthetic expertise in their surgery and results.

In our practice, it has become increasingly difficult to obtain insurance coverage for breast reduction surgery. Insurance companies frequently require 2-3 documented reports from other referred specialists before they’ll consider covering it. Also, the insurance companies commonly request 6-12 months of documentation and treatment by either a physical therapist, chiropractor, dermatologist or orthopedist.

What does this mean for a patient who needs the procedure due to chronic health problems caused by macromastia? Keep yourself updated on policies during this process, as the insurance company’s criteria are this year might not be the same next year.

If you feel that you are a candidate for breast reduction surgery and are requesting coverage under your health insurance, it is important that you contact your health insurance carrier and have them forward to you in writing their criteria for coverage. Every insurance company has different, independent criteria and indications. While your neighbor down the street may qualify for the procedure via one insurance carrier with a seemingly less severe situation, you may not be given the same answer by yours. On average, it takes between 3-6 months of preparation, including secondary consultations with other healthcare providers and possible therapy (physical therapy or chiropractics) to qualify for insurance coverage for breast reduction.

How do you handle this? Notify your primary care physician as soon as possible concerning any symptoms which may be related to your macromastia. It is never too early to start the process. Please contact your plastic surgeon’s office with any questions you might have that relate to breast reduction surgery and coverage through your health insurance and they can try to help guide you through the process, so that you can obtain the care you need.

How To Get Free Breast Reduction Surgery Without Insurance

Breast reduction surgery can help women who are unhappy with the shape, weight or droop of their breasts by making them smaller and more lifted.

But if it’s done to improve appearance rather than for health reasons, it’s not normally available on the NHS. Instead, you’ll need to pay for the procedure privately.

Information about breast reduction for cosmetic reasons is provided elsewhere.

This page focuses on when breast reduction might be available on the NHS.

Eligibility criteria for NHS breast reduction

The availability of breast reduction surgery on the NHS varies, depending on the eligibility criteria decided by your local integrated care board (ICB).

Some ICBs do not fund breast reduction surgery at all, and others fund it selectively if you fulfil certain criteria.

Generally speaking, you might be considered for breast reduction on the NHS if you have problems caused by having very large breasts, such as:

  • backache
  • shoulder or neck pain
  • skin irritation
  • rashes and skin infections under the breasts
  • grooves on the shoulders from bra straps
  • psychological distress, such as low self-esteem or depression
  • an inability to exercise or take part in sports

ICBs also tend to have additional criteria that may include the size of your breasts, your weight, your age, whether you smoke, and whether other options (such as wearing professionally fitted bras) have been tried, but have not helped.

You can find out what the eligibility criteria are in your area from a GP or by contacting your local ICB.

The referral process

See a GP if you think you might be eligible for breast reduction surgery on the NHS.

They can check whether you meet the criteria of your local ICB and, if you do, they can refer you to a breast or plastic surgeon for an assessment.

This may involve:

  • asking about the problems you’re having
  • checking your weight and general health
  • an assessment by a psychiatrist or psychologist
  • information about the risks and results of surgery

The assessment will help determine whether you’re suitable for surgery and whether there’s a strong enough reason for this to be done on the NHS.

The final decision is usually made by a panel of representatives from your local ICB, which will take into account the information from your assessments and a review of your individual case.

Things to consider before you go ahead

It’s important to discuss your problems and options with a GP and an appropriately qualified surgeon before having a breast reduction.

This will help you get a clear idea of what changes you can expect to see and ensure you’re aware of any risks involved.

Be aware that:

  • a significant reduction can alter the shape and look of your breasts
  • there will be scarring and possibly lost or altered nipple sensation
  • your breasts can change in size and shape after surgery – for example, they may increase or decrease in size if you put on or lose weight
  • breasts have a tendency to droop over time
  • your breasts can get bigger during pregnancy and you may not be able to breastfeed after surgery – so you may need to wait until you’re sure you do not want to have any more children

For women with very large breasts, the benefits of a reduction may outweigh any potential problems.

But for women with only moderately large breasts, the benefits may not be worth the risks.

Alternatives to breast reduction surgery

It’s sometimes possible to reduce problems caused by having large breasts without the need for surgery.

The following measures may help:

  • if you’re overweight, losing weight can sometimes help reduce the amount of fatty tissue in your breasts
  • a professional bra-fitting service – for many women with problems caused by large breasts, getting a professional to fit a correctly sized bra can reduce discomfort
  • physiotherapy – exercises from a physiotherapist can sometimes help with aches and pains caused by large breasts
  • psychological support and treatment – this can help if your large breasts are causing emotional or mental health issues

Breast reduction surgery will usually only be available on the NHS if you have first tried alternative measures.

Breast Reduction Weight Requirements

Ideal BMI For Breast Reduction

The ideal BMI for a breast reduction procedure is 18.5 to 24.9. Women in this category are usually of a suitable weight for body contouring and less at risk of postoperative complications.

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