When you get a breast reduction, you can expect to feel more confident and comfortable in your own skin. But before you make the decision, it’s important to understand how much a breast reduction costs in Ontario, Canada.
When it comes to cosmetic surgery, there are two main factors that determine the cost: the procedure and the surgeon. The procedure itself isn’t that expensive—some people might be surprised at how little it costs compared to other cosmetic surgeries like liposuction or eyelid surgery. But what really drives up the price is who performs it.
In Ontario, there are only about 10 surgeons who specialize in breast reductions—and each of them charges different rates for their services. Some of these surgeons have been practicing for decades and have built up reputations for excellence; others are new and have never performed any procedures before. In order to find out which doctors offer the best value for your money (or plan on charging), we recommend doing some research online before going into any consultations so you can ask questions like “What are your credentials?” or “How many procedures do you do every year?”
In this article we will discuss about ohip breast reduction criteria and wait time for breast reduction surgery ontario
How Much Is A Breast Reduction In Ontario
Breast reduction is considered a reconstructive breast surgery by some, while others classify it as cosmetic surgery.
In Ontario it is a bit of both. Breast Reduction is covered by OHIP, however the OHIP (Ontario Health Insurance Plan) covers cutting out excess volume and repositioning the nipple. Plastic Surgeons often add liposuction to sculpt the breast to improve it’s appearance and to minimize scarring. This is done to enhance the ‘cosmesis’ of the breast and is not covered by OHIP. Large patients often have fatty tissue extending under the armpits. A typical breast reduction procedure does not involve the removal of this fat. If it were to be included, it would have to be cut out. Liposuctioning it out (which provides superior look by avoiding a large and long scar) is not an OHIP covered procedure.
Coverage by OHIP is not automatic. Every time a Plastic Surgeon plans to perform a breast reduction, he or she must submit an application for approval by OHIP. In that application the surgeon has to explain why OHIP should cover this procedure. If the surgeon can document that the patient’s large breasts (medically referred to as bilateral mammary hypertrophy or hyperplasia) are causing medical distress (not just a cosmetic distress), OHIP usually allows the surgery to go ahead. Typical medical issues patients may complain about are back pain, neck pain, shoulder grooving (from the pull of the bra), skin infection under the breast and skin breakdown because of problems with infection and moisture under the breast fold. Patient’s height, weight, and breast size are documented and should give an indication of how large the breasts are, and how likely they are to correspond with the patient’s problems.
Once the OHIP Approval for Surgery has been submitted, it usually takes 4-6 weeks to hear back from the Ministry. The response can be an approval to go ahead, a rejection, or a request for more detailed information about the patient before they make a decision. If an approval is obtained, the surgery can be scheduled. If an approval is not obtained, the patient has an option of proceeding with the surgery, however because the Ministry of Health has deemed it as a ‘Cosmetic’ issue, the surgical fee will then have to be paid by the patient. Fees for Breast Reduction without OHIP approval generally range from $4000-6000 + GST. This fee usually includes everything, including the sculpting Liposuction.
In other provinces and in the United States, coverage of Breast Reduction by insurance plans depends on various criteria. In some places it is considered a completely cosmetic procedure and it is not covered, while others have certain requirements for approval, such as a minimum amount of tissue that must be removed (to ensure that the procedure is a reduction, not just a lift) or that a patient must be a certain BMI (Body Mass Index) (to ensure that overweight patients first loose weight before seeking breast reduction).
Ohip Breast Reduction Criteria
Breast reduction surgery is covered by OHIP but requires application and preapproval by OHIP before surgery. Some techniques for breast reduction require liposuction and this is not an uninsured service; liposuction is not covered by OHIP. In this case, the patient is responsible for the associated costs.
OHIP Coverage for Breast Reduction Surgery
It’s really important to note that not every breast reduction case automatically qualifies for OHIP coverage and there are a few considerations. However, there are a few predictors that can help indicate whether or not you qualify.
Indicators that your breast reduction may be covered by OHIP:
- it has been deemed medically necessary, as opposed to strictly cosmetic
- you experience significant associated symptoms
- you experience frequent pain, including in the back, neck and shoulders
- your posture is impacted by the weight of your breasts
- your shoulders feel persistently indented from the pressure of your bra straps
- you experience other symptoms like impediments to exercise, rashes and skin irritation
- you are evaluated to have what’s known as “gross disproportion”
You do not require a referral from a doctor in order to have a free consultation with our surgeons about breast reduction. If you do happen to have one, that’s great too. However, it’s not a prerequisite to visit our clinic for this procedure. You’re welcome to have as many complimentary consults with our doctors as you need to help with your decision-making process.
During your free consultation, your surgeon will give you a comprehensive physical assessment. Based on what they see and what you discuss, they’ll be able to advise you at that time whether or not they feel you meet OHIP’s eligibility requirements.
The OHIP Approval Process
Once your surgeon has advised that you’re a good candidate for both breast reduction and OHIP eligibility, it’s actually quite straightforward and there’s nothing you need to do (aside from waiting, unfortunately). We will take care of submitting an application to the Ministry of Health of Ontario. It can take anywhere from about 6 to 8 weeks for the approval process to be completed. As soon as we hear back from OHIP, we will contact you right away and let you know their decision.
In the very rare case that your application is not approved, or if your surgeon determines that your particular procedure would not be eligible for OHIP coverage, we also have options for financing your breast reduction procedure if that’s something of interest to you.
Aspects of Breast Reduction Not Covered by OHIP
OHIP will approve only the reduction portion of your operation. This may sound a little confusing, since a breast reduction would seem to be strictly concerned with reduction itself. But often our surgeons incorporate an additional step in the procedure in order to achieve the most natural-looking result possible.
Most patients have a small roll of fat on the lateral chest (or side areas of the chest) and another roll at the front edge of the armpit. These pockets of fat will become more prominent and apparent when the breasts are smaller and lifted, creating a noticeably disproportionate look that is out of step with the overall result. In short, when this fatty tissue remains, it doesn’t look natural and is usually really out of line with the patient’s goals.
These areas need to be corrected with liposuction, which your surgeon performs at the same time. Because liposuction of fat for cosmetic reasons is not covered by OHIP, there is an additional fee for this. You will receive a firm quote for the cost of this aspect of your surgery after your first free consultation. If your surgeon determines this will be a necessary part of your operation—and to be clear, this is most frequently the case—it’s not optional and we won’t perform your breast reduction without it.
The decision to have surgery is a big one, and we know our patients don’t take it lightly. Cost is one of the many factors that go into making this choice. OHIP coverage for breast reduction is a great financial support for an operation that can improve not only the way your body feels, but the way you feel about yourself. While additional fees for liposuction may come as an unexpected surprise, they also amount to an investment in the best result possible and they eliminate the need for revision surgery to correct foreseeable unwanted outcomes.
Wait Time For Breast Reduction Surgery Ontario
There are a few stops on the journey to getting surgery. We track wait times at two key points.
Your family doctor refers you to a specialist.
From referral to specialist appointment
The number of days between your specialist getting the referral from your family doctor and your first appointment with the specialist.
You can search this data.
You meet with the specialist.
Tests and evaluation
The time it takes for you to get any tests (e.g. blood, x-ray, MRI), if necessary, or have further consultation with the specialist before they decide if you need surgery.
Because everyone’s situation is so unique, we can’t track this wait period.
You and your specialist decide to go ahead with surgery.
From decision to surgery
The number of days from when you and your specialist decide you will have surgery to actually having the surgery.
You can search this data.
You have surgery.
What the numbers mean
When you check wait times for a first surgical appointment or surgery, you will have access to a lot of data. Here’s a preview of what the measurements mean and an example of how someone can use them to estimate their wait time and inform questions for their doctor.
Priority level
To help doctors and hospitals care for patients most in need first, doctors assign each patient a priority level of 1 to 4. For non-emergencies, priority 2 is the most urgent. (Priority 1 means emergency, so those patients are seen immediately and not included in this wait times data.)
Because priority levels are assigned based on specific criteria, you can be sure your wait time is appropriate for your condition.
Meet Lori
Lori needs surgery to remove a cancerous tumour from her breast. The tumour is not growing quickly so her specialist has classified her as priority 3.
Target time
A target time is a common service standard that all specialists and hospitals in Ontario follow.
A common target time helps ensure your wait is fair and reasonable no matter which specialist or hospital you go to in Ontario.
