Breast reduction surgery is a highly effective means of reducing the size and weight of your breasts. This surgical procedure can be performed under general anesthesia, using a local or a regional anesthetic technique. After this surgery, some patients may experience scarring and scaring, along with infections and bleeding.
In this guide, we review the aspects of Breast Reduction Surgery Requirements, common problems after breast reduction surgery, how to get a breast reduction covered by insurance, and Is breast reduction a high risk surgery?
Breast Reduction Surgery Requirements
If your breasts are too large for your body and cause you pain, a breast reduction surgery may be an option for you. This procedure reduces the size of your breasts to a more appropriate size. Breast reduction surgery can also help improve self-image and self-esteem because it can reduce back, neck and shoulder pain caused by heavy breasts.
There is no height or weight requirement for breast reduction surgery. Surgery may be an option if you’re healthy enough to undergo general anesthesia and healing typically takes six weeks, but there are cases where it can take longer to heal.
If you’re considering breast reduction surgery, there are certain requirements that must be met. There is no height or weight requirement for breast reduction surgery. Surgery may be an option if you’re healthy enough to undergo general anesthesia, but there are cases where it can take longer than six weeks to fully heal. You must also have realistic expectations when considering breast reduction surgery, as results vary based on your body shape and size as well as the surgeon’s skill level.
You should also consider how long it will take before your insurance company approves coverage for the procedure (there’s no guarantee). If they do approve it, they may require additional information from your doctor confirming that you meet their criteria for approval prior to scheduling any procedures with them on file with their company’s billing department – so keep this in mind if you’re trying to get your finances organized beforehand!
You must have realistic expectations.
You will still have breasts after the surgery. You may even be able to nurse your child, but it’s important to note that since you will still have breast tissue and milk ducts, it is possible that they could become engorged with milk and cause pain in the days following the procedure.
If you’re considering having a breast reduction because of back or neck problems caused by large breasts, keep in mind that these issues can be addressed by other techniques like exercise or massage therapy before opting for surgery as a last resort. In addition, if you are considering breast reduction because of discomfort from wearing an underwire bra all day long (or any other type of clothing), remember that this discomfort is only temporary when compared to what your body may feel like after having surgery on any part of it!
Lastly though: if this is something we’ve talked about prior then trust me when I say there’s nothing wrong with getting breast reductions just because they look good too 🙂
Insurance coverage may be available depending on your particular health condition.
The best way to find out if insurance will cover your breast reduction surgery is to contact your insurance company directly. Each state has different rules and regulations regarding who can qualify for coverage and how much they pay.
In general, however, if you have a medical condition that causes your breasts to be excessively large (known as gigantomastia), then insurance may be more likely to cover the cost of breast reduction surgery in order to allow you greater mobility and comfort. This can be verified by writing a letter from your doctor stating that nonsurgical treatments have not helped alleviate any pain or discomfort caused by having very large breasts.
You must have tried nonsurgical treatments that didn’t work to reduce the pain of excessively large breasts.
- You will also need to have tried nonsurgical treatments that didn’t work.
- Your doctor may refer you to a physical therapist for exercises and stretches for your shoulders, back, and neck.
- If you smoke or use tobacco products, stop doing so.
- Don’t eat or drink anything for six hours before surgery.
Your breast tissue is fully developed, typically after age 18.
If you are under 18 years old, then your breast tissue has not yet been fully developed and it is unlikely that a breast reduction would be the best option for you at this time. If you have recently had your first period and don’t want breast reduction surgery, then wait until after your breasts stop growing before considering any surgical procedure.
Breast tissue development is not a requirement for patients who are undergoing any type of augmentation surgery (or reconstruction), as they may wish to increase their size even if no growth has occurred yet. However, because nipple reduction surgery involves removing some of the existing tissue in order to create smaller nipples on an otherwise large chest area, patients should have full development before undergoing nipple reduction surgery.
Breast reduction surgery has specific requirements, including having health insurance and trying other methods first.
- You must have tried other methods of reducing the size of your breasts. If you have, and they didn’t work, ask your doctor about options for breast reduction surgery.
- You must have health insurance that will cover the cost of surgery (for example, Medicare or Medicaid). Your surgeon can help you find out if your plan covers breast reduction operations in general or specific procedures such as liposuction or an implant exchange procedure.
- You’re generally healthy enough to undergo general anesthesia and should not be taking oral blood-thinning medications (warfarin) unless directed by your doctor after discussing the risks with him or her beforehand; these medications may increase bleeding during surgery and cause complications later on if used without careful monitoring by a team of healthcare professionals who understand its side effects well enough to treat them quickly when needed during recovery time afterwards.”
common problems after breast reduction surgery
With 17-year-old “Modern Family” star Ariel Winter about to walk the Emmy red carpet for her first major public appearance since reducing her breast size in June, the media are abuzz with stories about such surgery: celebrities who’ve done it, teens who are doing it and the number of women “coming out” to say how the operation changed their lives.
Indeed, many plastic surgeons refer to breast reduction as a “happy surgery.” Studies rank the operation as having one of the highest patient satisfaction rates among plastic surgery procedures. According to the American Society for Aesthetic Plastic Surgery, more than 114,000 women underwent the procedure in 2014 — a 183% increase since 1997. Women report alleviation of neck and back pain, relief from constant skin irritation, improved ability to exercise and enhanced body image.
————For the RecordSept. 17, 2:50 p.m.: An earlier version of this article incorrectly said Ariel Winter’s first post-surgery public appearance would be at the Emmys on Sunday.————
But something is missing from the glossy photos and glowing reviews, says one Los Angeles County resident. “I was shocked to read that Ariel Winter was up and running within five days, trying on dresses a week after her surgery,” says the woman, who also underwent breast reduction surgery in June, decreasing her bra size from a 36HH to a 36D. She asked that her name not be used to protect her privacy.
The experience she describes is different from the one Winter talks of in an interview with Glamour.com last month about her surgery and why she chose it. “Five days after my operation,” says the L.A. County woman, “I was heavily bandaged with drainage tubes. I have yet to go shopping for clothes and won’t until I’m completely healed. I’m still wearing the medical bra 24/7.”
Nearly three months post-surgery, her condition is not the norm — she contracted a bacterial infection, and, in her early 40s, she is decades older than the starlet. Even so, she says the media are doing the average woman a disservice by not painting a fuller picture of the recovery and possible complications.
“Yes, I’m glad I did it — and, yes, it has changed my appearance and is going to make my life better,” she says. “But what I wasn’t expecting was for my recovery to be so protracted and for it to be so painful. This wasn’t highlighted in the media.”
For those considering breast reduction, here is a glimpse into the process:
Dr. Michele Shermak, a surgeon at the Plastic Surgery Center of Maryland, compares breast reduction to fitting a pie into a smaller plate. “With breast reduction, we’re removing breast tissue, and we have to reshape the breast. It’s like shaping the pieces of a pie. We have to compress the pie down to a smaller area.”
Surgical techniques differ in where tissue is removed, where it is left behind and the incision pattern in the overlying skin. While it’s common to leave most of the tissue in the lower part of the breast, Dr. Kelly Killeen, a surgeon at Cassileth Plastic Surgery in Beverly Hills, says she tends to leave more in the middle to upper part of the breast, “because it gives ladies a more natural-looking cleavage and shape.”
The two main incision patterns are the “anchor shape” and the “lollipop.” The anchor pattern is the standard technique, where an incision is made around the areola, down the midline and across the bottom of the breast. With the lollipop pattern, an incision is made only around the areola and straight down the midline of the breast, without the third horizontal incision.
“For a very large breast reduction, over 500 or 600 grams, the [anchor shape] is best; a lollipop is best for a smaller breast reduction, between 300 and 500 grams,” says Dr. David Kulber, director of the Plastic Surgery Center of Excellence at Cedars-Sinai Medical Center. “It’s definitely case by case. It depends on scarring versus shape.”
The cost of breast reduction varies widely depending on geographic location and complexity of the procedure. According to the plastic surgery society, the average physician fees for the procedure were $5,521 in 2014 — but this doesn’t include fees from medical facilities, anesthesiologists or laboratories. The total cost for a breast reduction through Cassileth Plastic Surgery in Beverly Hills can range from $9,500 to more than $20,000.
Depending on a patient’s insurance plan, breast reduction may be a covered benefit if a patient can document a medical need. “Patients have to demonstrate that their breasts are large in proportion to their frame and that they have needed medical care because of the size of their breasts — for neck or back pain, rashes under breasts, chronic headaches or difficulty with physical activity,” says Killeen.
With any surgery, there is inherent risk to going under anesthesia, though the risk is low. Risks of the actual procedure include decreased sensation or loss of sensation in the nipple, infection, poor wound healing, asymmetry and the death of fat tissue in the breast. A scary, but very rare, complication is death of the skin on the nipple, which results in subsequent removal of the nipple.
“Most complications that happen with breast reduction are minor things, not major complications that land you in a hospital,” says Killeen.
Studies looking at breast reduction complications report widely differing rates, ranging from 14% to 52%. “It’s hard to understand what the complication rate is because it’s so variable,” Kulber says. “There is a big difference between a 300-gram reduction versus a 1,300-gram reduction. With bigger reductions, the surgery is more involved. With a smaller reduction, between 300 and 500 grams, the complication rate is less than 5%.”
Kulber adds that many women with large breasts are overweight, so they will also have a higher rate of diabetes and heart disease, which increases the risk of complication.
Shermak was the lead author of a study that reported a trend of higher infection rate and poor wound healing for women who underwent the procedure in their 40s and 50s. Women over age 50 had a significantly higher rate of post-operative complications. While women on hormone replacement therapy fared better, those who’d had a hysterectomy fared worse, suggesting that declining estrogen levels might play a role in poorer healing.
For younger women, one of the main concerns is post-operative difficulty in breast-feeding, though experts disagree on how real the concern is. Some studies have indicated a lower rate of breast-feeding success after reduction surgery, while others have indicated that the success rate is similar to that of women in the general population.
Even with her rocky recovery, the L.A. County woman says she would do the surgery again — which is typical of most patients, says Killeen, adding that breast reduction surgery is one of her favorite operations to perform. “I get to do this procedure that makes people feel better. But the wonderful icing on the cake is that they end up with beautiful, perkier, more youthful-looking breasts in better proportion to their body.”
What is the right age for breast reduction surgery?
In looking at potential complications, one might think there is an ideal window of opportunity — after childbearing, to eliminate worries about breast-feeding complications, but before the hormonal decline of menopause. Yet experts say it doesn’t happen that way.
“Women truly get it done at all ages; you don’t have to choose a time,” says Dr. Michele Shermak, a plastic surgeon in Maryland. A 2011 study she led indicated that women in their 40s and 50s had a higher rate of infection and poor wound healing after the procedure, but she emphasizes that higher complication rates in middle-age women reflect mere nuisances, rather than health-threatening emergencies.
Beverly Hills surgeon Dr. Kelly Killeen agrees, saying there is not a cut-off age. Instead, women should ask themselves whether they are healthy candidates. “If a 60-year-old woman is healthy as a horse, her heart looks beautiful on her annual exams and her labs are perfect — why not? Why would you deny her the benefits of breast reduction if she is a good candidate for surgery?” Killeen says.
On the other end of the spectrum are young women like “Modern Family” star Ariel Winter, large-breasted teens who experience medical symptoms and low self-confidence . Though there have been recent claims that an increasing number of teens are undergoing the surgery, data show otherwise. According to the American Society for Aesthetic Plastic Surgery, fewer teens had the surgery in 2014 than in 2005 and, over the last decade, the percentage of breast reduction patients 18 and under has remained steady.
Beyond potential breast-feeding difficulties, surgeons have additional concerns for teenagers considering the procedure. Shermak has operated on 16-year-olds, though she says it’s important to determine whether they are emotionally mature enough to make informed medical decisions.
“Not every teenage girl is ready for it,” she says. “They have to be educated; it’s not like a magic wand. They are going to have scars, they are going to have a recovery. This is not magic — it’s a process, and there are some long-term changes.”
There is also the possibility that a teenager’s breasts will continue to develop after surgery, though Dr. David Kulber, director of the Plastic Surgery Center for Excellence at Cedars-Sinai, says this still shouldn’t preclude them from having the surgery if they are experiencing symptoms. “If you’re operating on a 16-year-old, their breasts may grow and they may need another surgery. But letting them suffer until they’re 21 — I think that’s unacceptable.”
Elise Harrison, a resident of Maryland, had the operation in her mid-40s without complication. Nearing her 50s, she feels better about her body than ever before. Her only regret is that she didn’t have the operation when she was younger. She says, “I would have had more confidence and higher self-esteem earlier in life.”
how to get a breast reduction covered by insurance
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.
The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.
Is breast reduction a high risk surgery?
Having very large breasts can lead to a number of health problems, both physical and psychological. For some, they cause chronic neck and shoulder pain, as well as headaches. For others, very large breasts may lead to poor posture, and ongoing back pain; some women may refrain from participating in sports or exercise because it is uncomfortable. And for some women, the issue may lead to mental health challenges such as depression, anxiety, or low self-esteem.
Breast reduction surgery (what medical professionals call “reduction mammoplasty”) may be an option. The procedure reduces the size and weight of the breasts, thereby relieving pain and other symptoms. In 2018, around 101,000 breast reduction procedures were performed in the United States.
Outcomes are usually excellent with women reporting greater comfort, improved body image, and better quality of life. “Our breast reduction patients tend to be our happiest and most satisfied population,” says Paris Butler, MD, MPH. “For many of us plastic surgeons, we view the operation as both reconstructive and cosmetic. We are alleviating the symptoms of back/neck/shoulder pain and rashes under the breast, while simultaneously making the breasts shapelier and placed at a more aesthetically ideal location on the chest.”
What is breast reduction surgery?
Breast reduction surgery, reduction mammoplasty, or simply mammoplasty are all names for a surgical procedure to reduce the size and weight of the breasts. During the procedure, a surgeon removes excess breast tissue, fat, and skin to make the breasts smaller. The surgeon also reshapes the breast and relocates the nipple and areola (the dark area around the nipple)—what doctors call the nipple-areola complex (NAC)—so that it is better positioned on the now-smaller breast.
When is breast reconstruction surgery used?
Breast reduction surgery is often used to treat women who have symptomatic macromastia or gigantomastia, conditions in which the breasts are abnormally large relative to body size.
In order to be deemed “symptomatic,” there must be evidence that the weight and size of the breasts are causing chronic neck, back, and/or shoulder pain, bra notching, skin irritation under the breasts, or a number of other problems.
In general, breast reduction surgery is used to treat women with large breasts who experience any of the following:
With these symptoms, as well as documentation, many women can have their breast reduction surgery covered by their medical insurance provider. (Insurance companies may require that patients first try to treat their symptoms with physical therapy, a weight loss program, or other therapies.)
Women who do not have a medical need for breast reduction surgery (or who are denied coverage by their insurance provider) can still choose to have breast reduction surgery, but would need to pay for it themselves.
How should women prepare for breast reduction surgery?
Before undergoing breast reduction surgery, it is important to discuss the goals and risks of the procedure with the surgeon. Prior to having surgery, patients should talk to their doctor about their desired breast size. Women who plan to have children should discuss this with their surgeon, since breast reduction surgery may impair their ability to breastfeed.
Women with a family history of breast cancer, a palpable lump in the breast, or other breast cancer risk factors may need to undergo a breast cancer screening mammogram prior to breast reduction surgery. It may be necessary to stop taking certain medications, such as blood thinners, in the days or weeks leading up to the surgery. Because smoking can increase the risk for complications from breast reduction surgery, women who smoke should stop smoking 6-8 weeks before and after surgery.
What happens during breast reduction surgery?
During breast reduction surgery, patients are given general anesthesia, meaning they will be unconscious and will not feel any pain during the procedure.
Several surgical techniques are used for breast reduction. The surgeon will determine which technique is most appropriate for a given patient. For the most commonly used technique, the surgeon makes an incision around the areola and down the front of breast to the underside of it. The surgeon then removes excess tissue, fat, and skin from the breast, and may cut away some of the areola to reduce its size. The nipple and areola will then be repositioned. Finally, the surgeon uses stitches to close the incisions and reshape the breast.
Liposuction is sometimes also used to remove excess fat from—and to help reshape—the breast. There are several liposuction techniques, but in general, during liposuction a surgeon makes a small incision into which he or she inserts a tube. A special vacuum device is used to suction fat out of the body. In rare cases, breast reduction surgery may involve only liposuction.
What are the risks of breast reduction surgery?
Breast reduction surgery carries certain risks. These include complications that may occur with any surgical procedure, such as risk of infection of the surgical wound, blood clots, and bleeding.
Other potential complications specific to breast reduction surgery include:
Serious complications from breast reduction surgery are rare.
What is recovery from breast surgery like?
Typically, women who have breast reduction surgery can go home the day of the procedure. Sometimes, though, patients need to stay overnight in the hospital.
After surgery, the surgical wounds will be covered with bandages. In some cases, drainage tubes will be connected to the breasts. These drain excess fluid from the breasts and are usually removed within 1 to 5 days. Women may need to wear a surgical bra that fastens in the front or a sports bra 24 hours a day for several weeks while the breasts heal.
Swelling and bruising around the breasts are common after the procedure and may last for a few weeks. Pain may be managed with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Sometimes, prescription-strength medications are used to control pain.
Stitches will be removed and bandages changed during follow-up appointments. Scars from surgical incisions will be visible, but they will fade over time.
Women who undergo breast reduction surgery usually need to limit physical activity for several weeks. In most cases, women are able to return to work within 2 to 3 weeks after surgery.
What is the outlook for people who undergo breast reduction surgery?
Outcomes after breast reduction surgery are usually very good. Studies have found that women who undergo the procedure typically report reduced back, neck, and shoulder pain, fewer headache symptoms, alleviation of skin rashes, and improved posture. They are usually able to exercise more comfortably and can more easily and economically purchase bras. Lastly, after surgery women frequently report improved self-esteem, enhanced body image, and better quality of life.
What stands out about Yale Medicine’s approach to breast reduction surgery?
“Yale Plastic Surgery has some of the most well-trained plastic surgeons in the region, if not the country, who are all board-certified or board-eligible,” says Dr. Butler. “Yale’s Plastic Surgery team will work on your behalf to request coverage of the procedure by your medical insurance provider. We have several surgeons with extensive experience with breast reduction surgery, pre- and post-operative photos will be shown during a consultation, and all questions will be answered.”