Although breast surgery is considered a cosmetic procedure in most cases, there may be times when the surgery is actually medically necessary. Breast reduction surgery, for example, may be deemed “medically necessary” if large, heavy breasts are causing uncomfortable physical symptoms. Since a “medically necessary” categorization may mean insurance coverage for at least part of the procedure, it is important to understand the criteria by which insurance companies determine this categorization.

Symptoms of Excessively Large Breasts

Disproportionately large breasts can cause a myriad of physical problems for a woman, including:

  • Back and neck pain
  • Tingling in the hands and fingers
  • Permanent grooves in the shoulders from taut bra straps
  • Rashes and skin irritation underneath the breast
  • Difficulty participating in some physical activities

Insurance companies may require documentation of these symptoms before they will consider breast reduction surgery “medically necessary.” That documentation is likely to come from doctors, massage therapists, physical therapists and other healthcare providers that have treated you for pain or skin issues. Companies may also have requirements in terms of how long you have suffered from the physical symptoms and whether you have undergone any treatment for those symptoms in the past that has not been successful.

The Proportion Chart

In addition to the symptoms listed above, insurance companies will often look at the woman’s body proportions to determine whether to cover breast reduction surgery. Companies utilize a chart for this purpose that tells them how much breast tissue would need to be removed to bring the body into proportion. If the removed breast tissue reaches a certain threshold, insurance coverage will be provided.

In addition to measurements, some insurance companies will require photographs to see the proportions between the body and breast size. While these photographs can be uncomfortable for a patient, they may be a necessary step in securing insurance coverage. Rest assured photos will be non-identifiable, usually taken from the neck down.

Most insurance companies will use a combination of these facts to determine eligibility for insurance coverage. Fortunately, a plastic surgeon experienced in breast reduction procedures is also likely to be educated about insurance requirements and will help you collect all the documentation necessary to get coverage approval for your procedure. If insurance does not cover the procedure, or only covers a portion of the expenses, most plastic surgeons will also offer payment programs to make your breast reduction surgery more affordable for you.

Breast reduction surgery can do more than give you a more attractive body contour. For some patients, this surgery can eliminate painful symptoms and give the patient an improved quality of life overall. To learn more about breast reduction surgery, contact Hall Plastic Surgery at 855-851-4832.