Breast Reduction Surgery Covered by Insurance: Everything You Need to Know

Breast reduction surgery, also known as reduction mammaplasty, is a surgical procedure that aims at removing excess breast tissue, fat and skin to improve the shape and size of the breasts. The procedure can be performed for cosmetic or medical reasons, such as alleviating back pain, neck pain, shoulder pain or improving body contouring.

Breast Reduction Surgery Covered by Insurance: Everything You Need to Know

However, breast reduction surgery can be expensive, and many patients may wonder if it is covered by insurance. In this article, we will discuss everything you need to know about having breast reduction surgery covered by insurance.

Does Insurance Cover Breast Reduction Surgery?

The answer to this question depends on your insurance plan. Some insurance plans will cover breast reduction surgery if you meet certain criteria. However, other plans may not cover the procedure at all.

Most insurers consider breast reduction surgery a cosmetic procedure unless it is medically necessary. Therefore, they will only provide coverage if there is documentation showing that the patient has experienced severe physical symptoms caused by large breasts that cannot be relieved through alternative methods such as physical therapy or medication.

What are the Criteria for Insurance Coverage of Breast Reduction Surgery?

To obtain insurance coverage for breast reduction surgery, patients must prove that they meet specific criteria set forth by their insurer. These criteria may include one or more of the following:

  • Symptoms associated with excessively large breasts such as back pain, neck pain or shoulder grooving.
  • Documentation of previous attempts at non-surgical treatments such as weight loss or physical therapy.
  • Evidence of chronic dermatitis beneath the inframammary fold.
  • Physical limitations caused by large breasts that interfere with daily activities.
  • Confirmation from a physician that conservative treatment options have been tried without success.

Patients must also demonstrate that they have realistic expectations for the outcome of their surgery and understand any potential risks involved in the procedure.

How Can I Determine if my Insurance Plan Covers Breast Reduction Surgery?

The best way to determine if your insurance plan covers breast reduction surgery is to contact your insurance provider directly. You can find this information in your policy documents or by contacting the customer service department. Be prepared to provide documentation from your physician stating that the procedure is medically necessary.

If you are covered for breast reduction surgery, make sure to understand any copays, deductibles or other out-of-pocket costs associated with the procedure.

What if My Insurance Plan Does not Cover Breast Reduction Surgery?

If your insurance plan does not cover breast reduction surgery, there are still options available to help manage the cost of the procedure.

Financing options such as medical credit cards and loans can be used to pay for breast reduction surgery. However, it is important to note that these options may come with high-interest rates and fees.

Patients can also seek out surgeons who offer payment plans or cash discounts. Some surgeons may also perform the procedure at a reduced rate if patients agree to allow their case to be filmed for educational purposes.

How Can I Prepare for Breast Reduction Surgery?

Before undergoing breast reduction surgery, patients should follow their surgeon’s instructions carefully. This will include:

  • Stopping smoking at least 4 weeks prior to surgery.
  • Avoiding certain medications such as aspirin that can increase the risk of bleeding.
  • Preparing for a recovery period of several weeks that will require limited physical activity and rest.

What Can I Expect During Recovery from Breast Reduction Surgery?

Recovery from breast reduction surgery typically takes 2-4 weeks, depending on the extent of the procedure and individual healing times. During this period, patients will need to avoid strenuous activity such as lifting heavy objects or exercising until cleared by their surgeon.

Pain, swelling and bruising are common during recovery from breast reduction surgery but can be managed through medication prescribed by your surgeon. Patients will also need to wear a supportive bra for several weeks after their surgery to aid in healing.

Conclusion

Breast reduction surgery can be a life-changing procedure for patients who suffer from symptoms associated with large breasts. While insurance coverage for the procedure is not guaranteed, meeting specific criteria and obtaining documentation from a physician can increase the chances of approval.

If your insurance plan does not cover breast reduction surgery, there are still options available to help manage the cost of the procedure. It is important to fully understand any out-of-pocket costs associated with the procedure before undergoing surgery.

Finally, following your surgeon’s instructions carefully during preparation and recovery from breast reduction surgery can help ensure the best possible outcome.

FAQs

Does insurance cover breast reduction surgery?

Yes, breast reduction surgery is often covered by insurance.

What criteria do insurance companies use to determine if they will cover breast reduction surgery?

Insurance companies will typically consider the patient’s age, weight, medical history, and whether or not other treatments such as physical therapy have been tried before approving coverage for breast reduction surgery.

Are there any risks associated with breast reduction surgery that might make it ineligible for insurance coverage?

While there are always risks associated with any type of surgery, as long as the procedure meets the insurer’s criteria and is deemed medically necessary, there should be no issue getting it covered.

How do I know if I’m a candidate for breast reduction surgery?

The best way to determine eligibility for breast reduction surgery is through consultation with a qualified plastic surgeon who can evaluate your individual needs and medical history.

How long does it take to recover from breast reduction surgery?

Recovery time from breast reduction surgery will vary depending on the patient’s individual circumstances, but most patients are able to return to work within 1-2 weeks and resume normal activities within 2-4 weeks.

Will my insurance cover all of the costs associated with breast reduction surgery?

While insurance may cover the majority of the costs associated with breast reduction surgery, you may still be responsible for copays, deductibles, and any other out-of-pocket expenses required by your policy.

Can I get both breasts reduced during one surgical procedure?

Yes, it is possible to have both breasts reduced during one surgical procedure. This can help reduce overall cost and recovery time.

Is scarring a common side effect of breast reduction surgery?

As with any surgical procedure involving incisions, scarring is a common side effect of breast reduction surgery. However, a skilled plastic surgeon will work to minimize the visibility of scars as much as possible.

Will I be able to breastfeed after having breast reduction surgery?

Breastfeeding may be affected by breast reduction surgery, but it is still possible in some cases. Discuss any concerns you may have about breastfeeding with your plastic surgeon prior to the procedure.

How long will the results of my breast reduction surgery last?

While every individual case is different, the results of breast reduction surgery are generally long-lasting and can provide relief from pain and discomfort for many years following the procedure.

Leave a Comment