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Is a breast reduction covered by insurance?

Breast reduction plastic surgery

The condition of oversized breasts is clinically known as macromastia. When these excessively large breasts cause pain and other physical concerns, the condition is called symptomatic macromastia. Breast reduction cosmetic surgery can effectively treat these symptoms in some cases.

In such cases, breast reduction costs may be covered by insurance. Patients should discuss the possibility with their surgeon as well as the insurance provider. Cutting edge, notable, and board certified female plastic surgeon Dr. Kristi Hustak provides breast reduction to patients in Houston, Texas and surrounding locations.

Medical Problems Covered by Insurance

Some of the health problems caused due to excessively large breasts can be successfully addressed with breast reduction plastic surgery. Insurance coverage may be possible under the patient’s health plan in such cases. These medical conditions include:

  • Obesity arising out of diminished capacity of the patient to do physical exercises
  • Chronic pain in the neck, back, and shoulders
  • Pain in the chest wall
  • Shortness of breath
  • Frequent headaches
  • Shoulder grooving
  • Poor posture
  • Tingling and numbness in the hands
  • Disturbed sleep patterns
  • Rashes in the breast crease and in the bra strap grooves

In most cases, symptomatic macromastia has a straightforward diagnosis and will not require extensive medical investigation.

How Breast Reduction can Help?

Reduction mammaplasty or breast reduction can be a very effective treatment for symptomatic macromastia because it directly addresses the cause of the symptoms. Research studies have shown the benefits of breast reduction for patients with symptoms related to excessive breast weight.

Some of the health benefits of breast reduction surgery include pain relief, increased physical function, improved skeletal stability, better lung power, superior quality of sleep, reduction in headaches, and improved breast visualization on mammography. Breast reduction has high patient satisfaction rates, and only a rare patient may report lack of relief in her symptoms after the surgery.

Insurance Requirements

Heavy breasts create strain on the body structures, which makes insurance coverage of reduction mammaplasty a distinct possibility in such cases. Patients considering a breast reduction should first go through their insurance policy. If breast reduction is listed as a policy exclusion, no coverage may be possible even for medical reasons.

But in other cases, the insurance company may require the surgeon to write a letter outlining the patient’s symptoms and their physical findings. The surgeon should mention an estimate of the breast weight to be removed and request for coverage. This formality should be completed prior to scheduling the surgery because the insurer may not be obligated to pay if surgery was not preauthorized.

If an insurance provider denies coverage by defining breast reduction as a cosmetic procedure, the surgeon should explain to them about symptomatic macromastia and describe how breast reduction can help. Preauthorization may not be possible in standard Medicare and Medicaid plans.

Up-to-date insurers are usually familiar with the current standard of care for treating macromastia, and may approve coverage based on reasonable proof of medical necessity. Dedicated and standout female cosmetic surgeon Dr. Kristi Hustak receives patients from Houston, Texas and other neighborhoods and suburbs in the wonderful Lone Star State for breast reduction surgery.

For more information on procedures and treatments provided by board certified female plastic surgeon Dr. Kristi Hustak please call us to schedule a consultation at 713.322.7265 or click here. Offices in Houston, Texas.

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