Breast Reduction surgery can occasionally be covered by your health insurance.  However, most health insurance require permission, or pre-certification, to ensure payment.  To obtain pre-certification, your plastic surgeon will meet with you and discuss with your what needs to be done before surgery can be scheduled.  Health insurance companies across the country have different requirements, but some are fairly general and are widespread.

Having large breasts, or macromastia, is the most obvious reason for wanting a breast reduction.  Typically, you may be experiencing neck, back, and shoulder pain.  You may have grooving of the soft tissue and skin of your shoulders because of your bra strap creating a skin fold in your upper shoulders.

Intertrigo is a medical term for skin irritation.  This may occur in your breast fold, because your breast tissue is so heavy and may generate pressure on your breast fold area.  Documented cases of breast intertrigo may require skin creams or antibiotics to help prevent it.

You should have weight proportionate to height. Larger or overweight women may have larger breasts, and overall weight loss may result in smaller breasts.  Your health insurance company will probably not approve surgery for breast reduction if you are significantly overweight.

Physical therapy may help with neck, back, and shoulder pain.  If your family doctor has recommended physical therapy first, then this may help with your pain.  If you still have continued pain from bilateral macromastia despite  physical therapy, and this is documented, then you have a slightly stronger case to get your beast reduction surgery authorized.

Photographic documentation is key to get approval for breast reduction surgery.  Your plastic surgeon will probably take photographs of your chest, and then your health insurance company authorization panel will want to review them to ensure that you are a candidate for surgery.

Every health insurance company will vary a little in terms of what requirements they need regarding breast reduction surgery. You may have to take a more active role than you realize to get your surgery approved.  Although your plastic surgeon will usually handle the initial request and submission of forms, you may have to contact your health insurance company to speed the process along.

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at, or call our office at 415-362-1846.

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