Are Breast Reductions covered by Insurance?

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Yes and no, is the simple answer.  Breast reductions reduce the size and weight of the breast through various incisions that may or may not involve an incision at the breast crease (inframammary fold). Once the extra tissue is removed, the nipple is repositioned to the center of the breast. 

Breast reductions are good options for anyone that might not be happy with their breast size and appearance and would like them smaller.  This could be because they feel the breasts are disproportionately larger than their frame, or they are very active and perhaps interfering with their ability to perform certain activities, or merely that they just don’t like them.  These are reasons for a cosmetic reduction which is paid for out-of-pocket. Insurance will not cover a breast reduction in these cases as it is not medically necessary.

Now, as you can imagine, having heavy large breasts can at times cause pain. Due to the heavy weight, you essentially end up straining your neck and upper back muscles to hold that weight up.  This can leave a patient with upper back and neck pain.  Many women also tighten up those bra straps to hold the weight of the breasts, this eventually leads to shoulder grooving, those deep grooves on the shoulders. Overlapping of the breasts on the abdominal skin can cause rashes in these areas as the skin in these areas become moist from the skin on skin contact.  These are definitely pretty significant things that can occur due to heavy breasts.  If these symptoms have been treated by your medical doctor either with medications, creams, or physical therapy, you might be a candidate for a breast reduction that IS covered by insurance.  The other caveat to all of this is that you need to have sufficient breast tissue that can safely be removed that meets the criteria of your insurance. This is usually based on a number determined by your body surface area.

So there you go.  Breast reductions can be covered by your insurance IF it is medically necessary AND you have failed conservative treatments AND we can remove a certain amount of breast tissue.  If you experience any of these symptoms, make sure you begin that conversation with your primary care doctor and consult with a Board-Certified Plastic Surgeon.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.