Is breast reduction considered plastic surgery?

I am planning to have breast reduction surgery in February when I am off for a week from teaching.  I have had really bad back pain my entire adult life and finally said enough is enough, so I am going to go to a surgeon to be evaluated and hopefully get the procedure done.  If I am doing this for health reasons is it considered plastic surgery?

user1212996

F, 33, Connecticut

Each insurance company has its own guidelines for deciding what is and isn’t covered. Most women deemed eligible for breast reduction have neck, back and/or shoulder pain, or chronic rashes beneath the breasts. Another symptom that may be considered is numbness of the hands, but only if there is accompanying neck, back and/or shoulder pain. Shoulder grooves stemming from pressure on the bra straps from large breasts also require consideration.

Another very important factor insurance companies take into account is the quantity of breast tissue that needs to be removed. The amount of tissue, as with other factors, varies depending on the insurance company. Some carriers insist that patients first try physical therapy or undergo a back exam to rule out other potential causes.

Unfortunately, insurance companies seem to go out of their way to avoid paying for breast reduction surgery. This is unfortunate because even minor breast reductions alleviate symptoms like back pain, shoulder pain and certain types of headache.

Beware: some insurance companies insist that a certain amount of tissue must be removed. Unfortunately, some patients go along with this, with no clue that they’ll be disheartened with the results (extremely small breasts). If your carrier demands this, don’t be afraid to push back.

If your insurance company denies you coverage for breast reduction, another possible option is to approach the plastic surgery department at a teaching hospital. If a plastic surgery resident performs the procedure, you may receive a breast reduction at a minimal cost.

Dr. Jonathan Heistein has 5 Breast Reduction before & afters:

Breast Reduction before image performed by Dr. Jonathan HeisteinBreast Reduction after image performed by Dr. Jonathan HeisteinBreast Reduction before image performed by Dr. Jonathan HeisteinBreast Reduction after image performed by Dr. Jonathan HeisteinBreast Reduction before image performed by Dr. Jonathan HeisteinBreast Reduction after image performed by Dr. Jonathan HeisteinBreast reduction before image performed by Dr. Jonathan HeisteinBreast reduction after image performed by Dr. Jonathan Heistein

» View Dr. Jonathan Heistein's full profile

Each insurance plan has its own criteria for coverage of breast reduction. Over the past few years the number of plans covering this surgical procedure appears to have decreased. Even when covered, some insurance plans establish a minimum quantity of breast tissue that must be removed in order to qualify for breast reduction. Some carriers peg the amount to your body mass index (BMI) while others demand extensive documentation of physical discomfort, such as back pain, neck pain or rashes caused by overly large breasts. The only way to know for sure is to check with your health insurance company.

Breast reduction may be considered plastic surgery depending on the insurance carrier, the gravity of your symptoms, and other factors. Coverage varies significantly depending on the insurance company and policy. Therefore it’s very important to check the fine print in your policy to see if breast reduction is considered a medical necessity in your case.

Insurance companies focus on several factors when deciding whether you are a good candidate for breast reduction surgery. One of the most important is the volume of fat and breast tissue that needs to be extracted. Many carriers consider a woman eligible if her excess breast tissue weighs at least 500 grams on each side, but some require a kilo or more. In rare cases, 350 grams may be considered enough excess to warrant insurance coverage.

Another thing insurance companies consider is physical symptoms, including neck, back and shoulder issues, rashes beneath the breasts, and any other issues that interfere the carrying out  of everyday activities.

Documentation from a physical therapist or orthopedic surgeon can be helpful towards proving to your insurance company the veracity of your physical problems. Other helpful documentation may include receipts for bras that prevent shoulder-grooving and/or creams to treat rashes. Usually, breast reduction surgery helps with these issues, but there are no guarantees. If your back pain is the result of some other issue, such as a herniated spinal disc, breast surgery will do little to alleviate the problem. Your insurance company will probably want to make sure other medical conditions aren’t responsible for your back pain before deciding if the procedure is medically necessary.

Sometimes plastic surgery can have both medical and cosmetic benefits, and breast reduction is one of the best examples of this. But the aesthetic benefit should not have any bearing on your insurance carrier’s decision, so long as the procedure is medically necessary. Consequently, it is important that you provide the insurance company with as much documentation as you can.

Dr. Christine Blaine has 1 Breast Reduction before & after:

Breast Reduction before image performed by Dr. Christine BlaineBreast Reduction after image performed by Dr. Christine Blaine

» View Dr. Christine Blaine's full profile

Breast reduction is one of the procedures frequently done for therapeutic reasons to relieve back, neck and shoulder aches but you will need to get prior authorization from your insurance company


Dr Corbin

www.thebreastexpert.com

When you say" is breast reduction plastic surgery"\?' you really mean to ask if it is cosmetic surgery. The scope of plastic surgery includes many areas including reconstructive, hand, burn and congenital surgery in addition to cosmetic surgery. Breast reduction if associated with medical problems such as back and neck pain can often be covered by health insurance. You should consult with a Board Certified PS with lots of experience performing breast reduction. good luck1

Breast reductions may or may not be covered by insurance. You have to check with your insurance company to see what their criteria are. Good luck.

Yes plastic RECONSTRUCTIVE surgery. Many health insurance plans cover the costs for medically necessary reductions. While other plans have restrictions to coverage. Best to call your heath plan to find out what is covered. 

Breast reduction surgery is considered plastic surgery however it may be covered by insurance depending on your symptoms and presentation. See you board-certified plastic surgeon for your care. 


DrBurnett#realself100