Getting Insurance Coverage for Breast Reduction

 The Usual History for a Patient Seeking Insurance Coverage for Reduction Mammoplasty: 

  • A history of always being large breasted (even in high school)
  • Difficulty in performing the more strenuous activities as a teen because of her chest size
  • After Child bearing the breast usually enlarge and the below noted  symptoms may become even more pronounced
  • Sharing of her concerns with her mother and or her primary care physician
  • Initiation of Conservative treatment options to relieve symptoms which may prove non-helpful
  • Referral to Breast Specialist for evaluation to determination if she is a candidate for the procedure

The Most Common Symptoms of Enlarged Breasts

  • Neck Strain
  • Chest Wall Heaviness
  • Upper or Lower Back Pain
  • Bra Strap Irritation
  • Poor Posture
  • Rashes beneath the Breasts


How To Obtain Insurance Coverage
For a woman to be covered, it is essential that the following information be provided to her insurance carrier. The information listed below is compiled and forwarded to her insurance carrier by the Plastic Surgeons office:

  • The estimate describing the amount of reduction from the procedure (most patients will go from a D or DD cup to a C cup)
  • A detailed list of the symptoms present and their duration
  • Any records of a non-successful conservative treatment period
  • Documentation regarding her condition and any attempts to reduce symptoms from her primary care doctor

This LINK will take you to the recommended forms that should be completed prior to the visit with your Breast Surgeon. The completion of these forms  will help ensure a higher chance of approval and speed up the approval process.

 Anticipating The Surgery
After a patient goes through surgery, she can expect the following, as part of the plastic breast surgery procedure:

  • Overnight stay in the hospital
  • Pain level roughly between 2 and 5 on a scale of 1 to 10
  • A return to work within around two to four weeks (dependent upon the patients employment type)
  • Partial or full return of nipple sensation and ability to breast feed in 90% of patients

During my 30 years as a plastic surgeon the breast reduction procedure has been by far the most appreciated by my patients.  I attribute this to the fact that they not only feel better because of the reduction of their symptoms, but they also have an improved shape because the their breasts are also lifted with this procedure . The most frequent statement that we hear after the procedure is, “I should have done this years ago.”  Joseph W. Rucker M.D.

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