A woman preparing measurements to try to get her breast reduction covered by insurance

Is Breast Reduction Covered by Insurance?

Most plastic surgery is not covered by health insurance because it is considered cosmetic. However, there are exceptions to this, depending on the specific policy. One procedure that patients often have questions about in regard to insurance coverage is breast reduction. Although this surgery can be done for aesthetic purposes, there are many reasons patients seek out this surgery that go beyond appearance. Overly large breasts (macromastia) can cause pain and in these cases, breast reduction may be covered by insurance.

The information provided in this article is intended to give you a general idea of some of the factors insurance companies may consider when determining whether to cover breast reduction surgery. This can vary based on your policy. It is important to read the details of your plan and contact your insurance company to determine whether you may be able to get coverage for your procedure.

When Breast Reduction May Be Covered

If you are seeking surgery exclusively or primarily for cosmetic reasons, it is unlikely to be covered. However, some women experience physical issues as a result of their breast size. If other methods have not been able to resolve these concerns, breast reduction may be considered medically necessary.

Some common issues due to macromastia include:

  • Neck pain
  • Back pain
  • Shoulder pain
  • Nerve damage, which may result in a tingling sensation in the hands
  • Rashes
  • Trouble sleeping
  • Shortness of breath
  • Headaches
  • Difficulty exercising

Other Solutions for Problems Caused by Macromastia

Treatment by a chiropractor or physical therapist may be able to help with neck, back, and shoulder pain. Your primary care physician may also offer possible solutions. In many cases, you will be asked to try using over-the-counter pain medication to manage symptoms. A doctor may also recommend losing weight in some circumstances. It is important to follow all instructions your health care providers give you and to let them know if you do not experience relief.

Make sure to ask any professionals you see to document your symptoms and any treatment you undergo and let them know you are considering breast reduction. It may be necessary to provide this documentation to your insurance company. Before an insurance company will cover breast reduction, they will usually require proof that a patient has tried other methods for symptom relief. In many cases, this will need to last a minimum length of time for each treatment option.

Documentation from Your Plastic Surgeon

In addition to requiring documentation of non-surgical treatment attempts, your insurance company may require documentation from your plastic surgeon. This may include measurements, estimates of the amount of breast tissue that will be removed, and more. It is important that you know what exactly your insurance provider will require and that you maintain communication with them throughout the process. We are happy to provide this documentation as requested.

What If You Can’t Get Your Breast Reduction Covered?

If you are unable to obtain coverage through your insurance plan, this doesn’t mean you can’t get the surgery you desire. Whether you are interested in a reduction for aesthetic reasons, do not wish to wait for the insurance company to approve coverage, or don’t meet the necessary criteria, there are still options for making the cost of your surgery more manageable. At Hess & Sandeen Plastic Surgery, we offer financing through Care Credit. This can be a great way to split up your payments and we can answer any questions you may have.

Breast Reduction in Tucson

Our skilled plastic surgeons can perform breast reductions for self-paying patients as well as those using insurance coverage. We can help you feel more comfortable with your body.

To learn more about breast reduction, contact us today.