Qualifications For Breast Reduction Surgery

The prerequisites for breast reduction surgery are the same as for any other type of cosmetic procedure – a good candidate is an individual who has realistic expectations and is seeking long-term benefits. The final decision must be made by your surgeon, but this guide will help you determine if you qualify for such a major operation.

In this guide, we review the Qualifications For Breast Reduction Surgery, How many sizes can you go down with breast reduction, Do breasts grow back after reduction, and do i qualify for free breast reduction surgery.

Qualifications For Breast Reduction Surgery

Insurance companies have a variety of criteria that they use to determine if a breast reduction will be covered by your plan. It is also important to remember that these criteria may change from year to year. Although an insurance company may be known to cover a certain procedure, they may have negotiated specific contracts with specific exemptions with your employer that could have excluded a breast reduction.

Your insurance company may wish to learn about some or all of the following criteria to determine if your procedure will be covered:

1. Signs and symptoms for which a breast reduction may be medically indicated. Insurance companies assign specific numeric codes to medical problems or symptoms called ICD-9 (International Classification of Diseases) codes. Large breasts (ICD-9: 611.1) can cause postural backaches (ICD-9: 724-5, 781.9), and upper back and neck pain (ICD-9: 724.1, 723.1). Skin irritation referred to as intertrigo (ICD-9: 695.89) as well as pressure leading to ulnar nerve parasthesias or numbness (ICD-9: 782.0) may also be related to excessively large breasts.

2. Body mass index (BMI). This is a number that is used to determine your weight status. It correlates your height and weight and should be used as a general guideline only. See the bottom of this document for information on the BMI and how to calculate it.

Some insurance companies will deny breast reduction surgery unless the BMI is <30, others <35, while others need to see documentation that the patient has attempted to lose weight in the past through diet, exercise or weight loss surgery. This is because breast size may decrease with weight loss.

3. Weight of breast tissue removed. Most insurance companies will want to know the weight of breast tissue the plastic surgeon believes he or she can remove during a breast reduction. This number may be 450 grams, 500 grams or 600 grams. Some companies have a more detailed approach to avoid penalizing patients who are of smaller stature but who have proportionately smaller breasts. These companies will correlate the body surface area (BSA) with the weight of the specimen removed. So, in these cases, for small individuals the amount of volume that needs to be removed for coverage may only be 325 grams, whereas for larger individuals this weight may need to approach 1,000 grams.

4. Breast reduction to match a breast treated for breast cancer. A breast reduction is also covered if it is to balance a healthy but larger breast with the other breast that has been affected by breast cancer and its treatment. This is protected by the Women’s Health and Cancer Rights Act of 1998. This ensures reconstructive treatment of the affected breast as well as balancing procedures to match the healthy breast to the reconstructed breast. This may include a breast reduction of any size.

5. Supportive letter from another physician or health care provider. Although a plastic surgeon should perform your breast reduction, he or she is likely to have just met you for the first time during consultation. Your insurance company may request supportive letters from other health care providers to support the request that a breast reduction will treat your medical symptoms. This supportive letter may also serve to document that attempts at weight loss, exercise and physical therapy have already been made to treat the symptoms of excessively large breasts. It may also be necessary to document cases of rashes or intertrigo.

6. Photograpy and measurements. Your plastic surgeon may submit de-identified photos of you as well as specific measurements to quantify the size of your breasts relative to your frame to provide further evidence that a breast reduction may be medically indicated.

How many sizes can you go down with breast reduction

Excessively large breasts can also restrict a woman’s individual lifestyle and make it difficult to exercise comfortably.

Breast reduction surgery can offer significant relief to these common problems. Medically referred to as reduction mammoplasty, breast reduction surgery can reduce the size of your breasts and improve the overall proportions of your physique.

Board-certified plastic surgeon Dr. Raymond Jean has helped many women improve their figures, confidence, and quality of life through breast surgery. He will customize your procedure to meet your unique goals. When discussing desired outcomes of breast reduction surgery, women often ask how much of a reduction is possible. Simply put, the answer is: it depends.

How Many Sizes Down Can You Go With Breast Reduction?

Typically, most women drop one or two cup sizes with breast reduction surgery. This is usually sufficient to alleviate the many problems associated with overly-large breasts, while still maintaining an attractive and proportionate body shape.

During your initial consultation with Dr. Jean, He will assess your physical condition, review your medical history, and determine your candidacy for breast reduction surgery. Together, you will develop a customized treatment plan that reflects your individual goals and desired outcome.

We encourage you to visit our before and after gallery to see examples of Dr. Jean’s exceptional breast reduction results.

Do breasts grow back after reduction

Although breast augmentation is usually the first thing that comes to mind when people think of cosmetic breast surgery, there are actually several beneficial procedures available to address a wide variety of concerns, including breast size, shape, position, asymmetry, and more. Breast reduction, for example, is designed to reduce the overall weight and volume of a woman’s breast to give her a more natural look and relieve common symptoms associated with large breasts. The caring and experienced team at Romanelli Cosmetic Surgery, led by board-certified plastic surgeons Dr. James Romanelli and Dr. John Layliev, are proud to offer Long Island, NY breast reduction surgery to help women finally look and feel more confident and comfortable than ever before.

To find out if breast reduction may be right for you, it is helpful to first have a basic understanding of the procedure itself, including what it is used for, what results are possible, and how long they may last. One of the most common questions when it comes to breast reduction surgery is whether or not the breasts can grow back later in life. Find out the answer here.

What is breast reduction?

Breast reduction is a surgical procedure that involves removing glandular breast tissue and fat to reduce the size, weight, and volume of the breasts. In most cases, excess skin is also removed during breast reduction surgery in order to lift the remaining breast tissue to a more youthful, perky, and appealing position.

Do I need breast reduction?

There are a number of reasons that women may pursue breast reduction in Long Island, NY. In some cases, patients simply desire a smaller breast size. For the most part, though, breast reduction is performed to relieve painful symptoms and improve the patient’s overall quality of life, allowing them to wear their preferred styles of clothing and participate in physical activity and exercise more comfortably. Some of the most common signs and symptoms that may indicate breast reduction could benefit you include:

If you are experiencing any of these signs or symptoms associated with your overly large and heavy breasts, then breast reduction may be a fantastic option for you. During your initial consultation at Romanelli Cosmetic Surgery, Dr. Romanelli or Dr. Layliev will thoroughly discuss your concerns and tailor a custom surgical plan to help you achieve your ultimate goals.

Can your breast grow back after reduction?

While it is exceedingly rare, breast growth after reduction surgery is possible in some cases. During the procedure, your surgeon will remove a portion of your glandular breast tissue. If the remaining tissue becomes enlarged at some point in the future, the breasts can increase in size. Breast regrowth after breast reduction surgery can be due to pregnancy, breastfeeding, weight gain, menopause, hormonal changes, medications, aging, and other factors. Typically, patients who have breast reduction performed at a younger age – before their breasts have fully developed – are more likely to experience future breast enlargement. In general, though, breast reduction can provide permanent or long-lasting results.

If you do experience breast regrowth after breast reduction, try not to worry. Most women in this situation are able to undergo breast revision surgery to restore their ideal look.

Does insurance cover breast reduction?

For many women who are experiencing pain, discomfort, or other symptoms associated with their large breasts, breast reduction surgery may be covered by insurance. The knowledgeable team at Romanelli Cosmetic Surgery has extensive experience in helping patients obtain insurance coverage for breast reduction surgery and will work with you to determine your eligibility and submit the necessary paperwork.

Am I a good candidate for Long Island, NY breast reduction surgery?

Most women who are in good health, do not smoke, are at a healthy and stable weight, and are not pregnant or planning to become pregnant can be considered for breast reduction surgery. Because the procedure is highly individualized, it is essential to be evaluated by a qualified, experienced, and skilled plastic surgeon to determine which procedure(s) is most appropriate for you.

Call the friendly team at Romanelli Cosmetic Surgery in Huntington, NY to schedule your in-office or online consultation with board-certified Long Island plastic surgeons Dr. James Romanelli and Dr. John Layliev today, and take the first step toward getting relief from your painful symptoms, feeling more confident, and looking more beautiful than ever before!

do i qualify for free breast reduction surgery

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.