A breast reduction, or reduction mammaplasty, is a surgery done to make your breasts smaller and lighter. This surgery can be considered both cosmetic and reconstructive. Many women with very large and heavy breasts suffer from neck pain, shoulder pain, tension headaches, rashes and infections under their breasts. Very large breasts may also adversely affect self-confidence and this can start during puberty, having long-lasting effects on self-confidence. Some women are very self-conscious about the size of their breasts and cannot exercise or wear the type of clothing they would like.
If you suffer from any of the above concerns, you may be a good candidate for this operation. Oftentimes, insurance companies will cover breast reduction surgery, although there are generally strict criteria to qualify. If you are wondering if your insurance company would cover such a procedure, you may call them and find out their criteria. The following questions will help to determine if it is worth pursuing through your insurance company:
- Have you been to a doctor in the past 2 years to discuss any pain that you may be experiencing due to your breasts being large, including neck pain, shoulder pain, or upper back pain?
- Are you currently seeing a doctor for chronic shoulder pain, neck pain, rashes or infections under your breasts?
- Have you ever had an infection or rash under your breast for which you have been seen by a doctor?
- Have you ever been sent to physical therapy or a chiropractor due to neck and back pain?
- Has any doctor prescribed medication for your pain or told you to take medications like ibuprofen regularly for your pain?
- Have you had X-rays or an MRI of your neck or back?
If you answered yes to 3 of these questions, you may qualify for an insurance covered surgery. However, you must be aware that obtaining authorization for a reduction mammaplasty can be a lengthy process, especially if your primary care doctor recommends a 3-month trial of medication, weight loss, X-rays, or physical therapy which are things that your insurance company may require. Because insurance companies require very specific information, you will need to make sure that you have everything they will be asking for. Before you schedule a consultation with Dr. Fisher, you will need to see your primary doctor in order to obtain the needed documentation. You will need to provide the following documentation from your primary care doctor:
- Doctor’s History & Physical and office progress notes documenting the problem of large breasts AND neck/back/shoulder pain, headaches, rashes, or infections.
- Documentation must include at least a 3-month trial of medical therapy AND a course of physical therapy or chiropractic treatment all of which have failed.
- Any X-rays or MRI for neck/back/shoulder pain.
- Mammogram within 1 year for any patient age 25 or older.
- Documented weight loss without relief of symptom if patient has a BMI over 35
If you cannot obtain this type of documentation, your surgery is unlikely to be covered by insurance. If insurance does not cover a procedure it is because they do not consider it medically necessary, and you would then have the option to pay for it as you would for any other cosmetic surgery.
Why Choose Dr. Orna Fisher?
- Virtual Telehealth Consultations for Convenience & Privacy
- Boutique Practice, Private and Personalized
- Double Board Certified Female Plastic Surgeon
- Member of the American Society of Plastic Surgeons
- Member of the International Society of Aesthetic Plastic Surgery
- Voted Best Cosmetic Surgeon in the Best of Silver State Awards and Multiple Top Doctor Awards
- Participates Consistently in Continuing Education to Provide Best Practices
- Known for Her Surgical Precision and for Her Personalized Approach With Patients
- Mission is to Provide Her Patients With Top Quality Plastic Surgery and The Latest Cosmetic Procedures