Patients assume that if a surgery is classified as reconstructive, it is medically necessary and will be paid by insurance. Many patients, on the other hand, believe that if an operation is considered aesthetic, it is neither medically needed or covered.
Breast reduction, on the other hand, is often classified as a cosmetic procedure for insurance purposes until the patient can demonstrate a sufficient number of health difficulties and attempts to address those issues prior to undergoing corrective surgery. Once the threshold is met, the insurance company may consider breast reduction to be a reconstructive treatment for that patient and pay for it. The issue is that each insurance company or insurance company reviewer may have a different threshold. Breast reduction surgery has long been regarded of as a “hybrid” operation, in my perspective. It is classified as reconstructive in order to qualify for insurance coverage, but it is also classified as cosmetic in the sense that consumers anticipate thorough aesthetic skill in their surgery and results.
In our clinic, obtaining insurance reimbursement for breast reduction surgery has become increasingly challenging. Before considering coverage, insurance companies often demand 2-3 written reports from other referred specialists. In addition, insurance companies frequently need proof and treatment from a physical therapist, chiropractor, dermatologist, or orthopedist for 6-12 months.
What does this entail for a patient who requires the operation due to macromastia-related chronic health issues? During this procedure, keep yourself up to speed on policies, as the insurance company’s criterion this year may not be the same next year.
If you believe you are a candidate for breast reduction surgery and want your health insurance to cover it, you should contact your health insurance provider and request that they send you their coverage criteria in writing. Each insurance business has its own set of criteria and indicators. While your next-door neighbor with a seemingly less serious problem may qualify for the operation through one insurance carrier, you may not receive the same response from yours. To qualify for insurance coverage for breast reduction, it takes an average of 3-6 months of preparation, including secondary visits with other healthcare specialists and possibly therapy (physical therapy or chiropractics).
Does a breast reduction include a lift?
A breast lift is not included in breast reduction surgery. A breast lift is included in all breast reduction operations. After the extra tissue is removed in a standard breast reduction, the nipple is lifted to a more suitable position as part of the redraping process.
How do I get my insurance to cover a breast reduction?
Large breasts (macromastia) can produce physical problems that interfere with a woman’s daily functioning, as I discussed in my earlier post. Symptomatic macromastia is a well-known medical disorder that requires treatment. Insurance coverage of reduction mammaplasty is just as suitable as coverage of cervical spine surgery, shoulder surgery, carpal tunnel release, or sleep apnea treatment because big breasts put constant strain on body systems. Non-surgical treatments should be attempted initially for some disorders, but there are no non-operative treatments for macromastia that are expected to provide long-term or permanent symptom alleviation.
If you’re thinking about having breast reduction surgery, make sure you read your insurance coverage first. If your insurer specifies reduction mammaplasty as a policy exclusion, you might not even be able to get coverage for a consultation to see if surgery is right for your symptoms.
In most situations, insurers demand that the surgeon produce a statement outlining the patient’s symptoms and physical results, as well as an estimate of the breast weight to be removed and a request for coverage. This should be done before scheduling surgery since if surgery is not preauthorized, the insurer may refuse to pay. If your insurer refuses to pay breast reduction surgery because it is considered cosmetic, your doctor must inform the insurer about symptomatic macromastia and the differences between breast reduction and its aesthetic cousin, the breast lift. Traditional Medicare and Medicaid plans may not offer preauthorization.
Current insurers should be aware of the current standard of care for treating macromastia and should accept coverage based on reasonable criteria and medical necessity verification. Unfortunately, too many insurance companies have yet to study the medical research from the last two decades demonstrating the usefulness of breast reduction surgery in alleviating macromastia symptoms independent of a woman’s body weight. Many of these businesses employ a chart based on the Schnur Scale of 1991, which correlated a woman’s reasons for breast reduction with her body weight. Because of their position on the chart, many women are denied coverage. The use of such a chart to discriminate against overweight women by refusing them coverage regardless of their symptoms has no medical validity, according to recent medical research, but insurers continue to do so.
Your doctor’s report of your symptoms and physical changes caused by your breast weight should be utilized to determine medical necessity. Even though non-surgical therapy trials have a low chance of success, they may be required before surgery is covered by insurance. Although it is reasonable for an insurer to require that a certain amount of breast tissue be removed, there should be a mechanism in place to ensure that special circumstances (such as a small-framed woman or a woman with a medical condition made worse by even moderate breast weight) are given special consideration.
You have the legal right to appeal a denial if you believe breast reduction is important for your health and well-being. The denial letter should include information about the appeals process. Multiple levels of appeal are available in most circumstances, and you should take use of them. A family doctor’s letter, an orthopedist’s letter, a physical therapist’s letter, a chiropractor’s letter, or a massage therapist’s letter can all help support an appeal. You should create your own letter in which you describe your symptoms and how they have hampered your life (focus on your physical problems rather than your difficulty finding a bathing suit). Request that your doctor attach your personal letter, supporting letters, current scientific information on the standard of treatment for treating symptomatic macromastia, and a list of medical literature references to your appeal.
How much is a breast reduction 2020?
According to 2020 figures from the American Society of Plastic Surgeons, the average cost of a breast reduction (for cosmetic purposes solely) is $5,913. This is only a portion of the entire cost; it excludes anesthesia, operating room facilities, and other related costs.
How big do breasts have to be for reduction?
According to Dr. Bernard, the surgery is an outpatient procedure that takes roughly three hours. Women usually return home the same day or the following morning. However, you’ll most certainly be exhausted and hurting afterward, so take a few days off work or school to recover. You’ll be encouraged to get up and move around on a daily basis, but any strenuous exercise should be avoided for about a month, he advises.
You might not be able to get the exact cup size you want
The extent to which your breasts can be lowered is determined by your size, breast composition, and desired results. Your plastic surgeons will assist you in determining the best course of action throughout your consultation. According to Dr. Bernard, most breast reduction patients lose one to two cup sizes.
You’ll get a breast lift, too
Your surgeon will remove superfluous tissue and skin from your breasts to make them smaller, and then relocate your nipples up in place to give them a lift.
You’ll have scars
For a period, the incision wounds (which commonly resemble lollipops and loop around the nipples before going straight down to the bottom of the breast) will swell. “Scars improve dramatically in most people within a year of surgery, but they’re always there,” Dr. Bernard explains.
“It’s just as much genetics as anything else when it comes to scars. Every plastic surgeon can close a wound well, but it all relies on the individual.”
There’s a chance you’ll have decreased nipple sensation
Your nipples may feel numb immediately after surgery. “Almost invariably, some sensation in the nipples returns, although it may take a month or two,” Dr. Bernard explains. Certain surgical approaches are more likely to retain nipple sensation, so if this is a concern for you, make sure to discuss it with your surgeon.
How much does DD cup breast weigh?
For both of your breasts, DD cups can weigh up to 4.2 pounds. Each of your breasts may weigh around 950 ml or 2.09 pounds if your bra size is a DD cup. Your bra size can also help you estimate how much they weigh.
How much is a breast reduction out of pocket?
- A breast reduction normally costs between $5,000 and $7,000. According to The American Society for Aesthetic Plastic Surgery, this estimate includes anesthesia fees of $1,000 to $1,500 and facility fees of $500 to $2,000, as well as the surgeon’s fee, which averages $5,500. Very big breasts that require more tissue removal and reshaping of the nipple area might expect to pay more. As a result, a doctor will need to conduct an in-office consultation in order to provide an exact cost estimate.
- The surgeon makes incisions in the breast, usually around the areola and beneath the breast, and then removes excess fat and tissue to achieve the desired size. Because the weight of huge breasts can stretch the areola, the doctor would usually lower the size of the areola, then remove superfluous skin and lift the breast to make it higher and firmer. The surgeon frequently leaves the nipple attached during surgery to preserve nipple feeling and the ability to breastfeed.
- Breast reduction treatments are described and illustrated by the American Society for Aesthetic Plastic Surgery.
- Post-surgical support bras, which typically cost over $100 each, and a hot/cold breast compress, which costs around $25. Doctors will also prescribe pain medicine, which may or may not be reimbursed by insurance.
- Additional surgery may be required in some cases, either due to problems or because the patient is unhappy with the results. This can be just as expensive as, if not more expensive than, the first treatment.
- Ask your surgeon if permitting your before and after images to be used on websites or in commercials will get you free or discounted treatments.
- Health insurance will often cover the cost of breast reduction because it is not necessarily considered a cosmetic procedure and can help with health issues including back discomfort and posture issues. Consult your insurance company as well as your doctor, who may be required to submit a letter saying that the reduction is medically necessary.
- Look for a board-certified plastic surgeon who has a lot of experience with breast surgery. A free recommendation service is provided by the American Society of Plastic Surgeons. Discuss the benefits as well as the hazards with your surgeon, which include infection, numbness or a change in nipple sensation, and even loss of circulation to the nipple, which may necessitate nipple removal. Smokers are more likely to lose their nipples, therefore they should stop smoking at least two weeks before surgery.
Will breast grow back after reduction?
Breast reduction is a surgical technique that involves the removal of skin, fat, and tissues from the breasts in order to contour, lift, and reduce their size. Breast reduction is getting more popular as women with huge breasts realize they don’t have to be self-conscious about them “Just live with it” is no longer an option. Breasts that are too big can hurt your self-esteem, lower your quality of life, and even cause physical issues like persistent back and neck pain. People considering breast reduction may question if it’s a permanent treatment, if it interferes with breastfeeding, and if there’s a best age to do it.
Breast reduction is permanent since the skin, fat, and tissues removed during the treatment are permanently eliminated and cannot grow back. Gaining weight, on the other hand, might cause additional fat to be deposited in the breasts, causing them to grow dramatically in size. Furthermore, pregnancy and breast-feeding can greatly increase the size of the breasts, and the aging process is well recognized to induce changes in breast size and shape. A second surgical treatment to reduce breast size or elevate aging sagging breasts into a more perky, young position may be required if necessary.
Because glandular tissue and milk ducts may need to be removed or damaged during the procedure, breast reduction surgery may make it difficult or impossible to breastfeed. However, some breast reduction surgical treatments have been created expressly to retain the capacity to breastfeed, so if you believe you might want to do so in the future, talk to our surgeon about it before the procedure. Breast reductions without any effort to retain breast feeding ability have been reported to result in just 4% of women being able to nurse, compared to 75 percent to 100 percent after a gland-preserving breast reduction. Unfortunately, the only way to know if you can breastfeed after a breast reduction is to try it and see if it works. If it doesn’t, don’t worry; human milk banks exist, and while it’s widely accepted that human milk is the best way to feed a baby, many infants survive on formula.
Mammograms, ultrasounds, MRIs, and physical examinations used to check for breast cancer will not be affected by breast reduction surgery. Some doctors may advise you to get a second opinion “About six months after breast reduction, get a “baseline” mammogram to get a record of what the scar tissue looks like in the post-surgical breast tissues, which can be compared to any future mammograms to see if there are any changes in the breast tissue that could indicate the development of breast cancer.
From the surgeon’s point of view, “After a woman has finished her family, she is at her “ideal” age for a breast reduction. She has no intention of becoming pregnant or breastfeeding in the future. The woman, on the other hand, sees the situation differently “The “ideal” time is usually in your late teens or early twenties. Procedures performed on younger teenagers before their breasts have fully matured may necessitate a follow-up procedure later in life to maintain the intended results, but many teenagers and their parents believe the numerous advantages of early breast reduction are well worth it.
While the media may glorify huge breasts, they can also bring a slew of issues. Finding comfortable, well-fitting bras that give adequate support can be difficult; some women develop deep grooves in their shoulders as a result of their breasts dragging their bra straps into their flesh. Fitting dresses and blouses are also difficult to come by, and many women with huge breasts wind up needing to wear clothing that is several sizes too big to accommodate their breasts, which is neither flattering nor professional. Women with enormous breasts may give the impression of being overweight, even if they are not.
Large breasts can bring health problems in addition to cosmetic issues. Many women with large breasts find it difficult to exercise because their breasts bounce, even when wearing heavy-duty sports bras, which can be uncomfortable and even painful. Furthermore, huge breasts can physically obstruct the performance of some types of activity. As a result, women with large breasts are less likely to exercise, which is harmful and increases their chance of acquiring illnesses such as cardiovascular disease and osteoporosis.
In an attempt to counterbalance the weight of their breasts, women with enormous breasts frequently acquire chronic neck, back, and shoulder pain by adopting abnormal positions. The area beneath the breasts is prone to chronic rashes and infections. Most insurance companies do not consider breast reduction surgery to be necessary due to the numerous medical problems associated with large breasts and their considerable influence on quality of life and self-esteem “cosmetic” and will pay for the surgery.
Before the treatment, it’s critical to have an honest and open conversation with our physician about your goals and desired breast size. Most surgeons nowadays have software that can display photos of the patient with various breast sizes to help them make decisions. You may be requested to have your blood tested to confirm that you are healthy enough to undertake a major surgical surgery, and you should cease taking anti-clotting medications like aspirin or ibuprofen for several days before the treatment.
The treatment itself takes a few hours and is conducted under general anesthesia; in many cases, the patient can go home the same day rather than remaining overnight. The precise surgical procedure is determined by the size of the breasts and the final size sought. The incisions will be made in places where they will not be seen, such as around the areola, in the crease under the breasts, and occasionally even in the armpits; nevertheless, an incision from the areola straight down to the crease under the breasts is frequently required. Liposuction is used to eliminate fatty tissues; tissue and skin are shaved away, and the areola is frequently pushed upwards as the breasts shrink. The areola and nipple may need to be fully removed and then reattached in a new position if the breasts are exceptionally enormous. After the surgery, the breasts will be smaller, perkier, and elevated.
Although complete recovery takes around four weeks, most women are able to return to work and normal activities within a few days. The breasts will be tender, bruised, and swollen, and you may need to wear a compression bra to help them heal. During this time, physical activity, particularly heavy lifting and anything that promotes significant breast movement, should be avoided. The altered size and form of the breasts will become obvious when the swelling subsides. After the procedure, many women report losing sensation in their nipples, but this normally recovers within a few months.
Many women are concerned about scarring prior to surgery. It’s true that scars will appear along the surgical incision lines. Modern treatments, on the other hand, place the incisions in places where the scars will never be seen while wearing clothing, even if you’re wearing a very low-cut blouse or a minimalistic bikini. Over time, the scars will disappear into very thin pale lines that are barely apparent. Scars are rarely a source of concern for women following surgery.
Unfortunately, there is no way to reduce breast size without surgery. For this purpose, creams, tablets, and herbal supplements simply do not function. If a woman loses a large amount of weight, she may see a reduction in breast size, but some women may not see any changes in their breast size as a result of losing weight. The breasts are a complex structure made up of glands and fat; some women have a lot of fat in their breasts, while others have very little. The effect of weight loss on breast fat is similarly unpredictable; some women’s bodies, even if they have an unhealthy low body fat percentage, severely oppose fat removal from the breasts. A major disadvantage of attempting to reduce breast size by losing weight is that the skin around the breast does not shrink in tandem with the breast, resulting in sagging flaps of skin that may require surgical removal.
Patient satisfaction with breast reduction surgery is among the greatest of any technique “Costume” procedure Patients are frequently amazed at how easy and quick the recovery is, and, more importantly, that their unpleasant symptoms associated to their huge breasts are entirely gone following surgery. The neck and back pain disappears, as do the recurring skin infections and rashes, and the bra strap grooves heal quickly. Many patients are required to purchase an entirely new wardrobe, but they are usually overjoyed to be able to finally wear comfortable bras and flattering apparel that fits. Women who have never been able to do anything more athletic than walk are now taking up soccer and training for marathons.
How painful is breast reduction surgery?
It’s common to feel some pain and discomfort in the days following your surgery. It’s possible that your breasts and the areas around them will be bruised and swollen. This is due to the stretching of the breast tissues and muscles.
The first few days after surgery are the most painful for most women. Your doctor may prescribe pain relievers if necessary to alleviate the discomfort.
Additionally, drainage tubes may be inserted on your breasts as part of the recuperation procedure to help reduce swelling. These are frequently removed after a few days of surgery.
Women recovering after breast reduction should wear specific surgical bras to protect the tissue during this time, according to medical specialists. Finally, throughout this time, it’s critical to avoid overly vigorous activity.
How can I get a breast lift with insurance?
Breast lifts are not covered by all insurance providers, and even those that do aren’t covered in all circumstances. The medical need of the surgery is usually the deciding factor. If the procedure is deemed medically essential, the insurance company may pay for it. This is especially true for women who require breast reduction surgery because their breasts are giving them other health problems. In some cases, a breast lift is also required to assure the effectiveness of the breast reduction surgery, and the insurance company may pay both procedures.
It doesn’t always matter whether you or your doctor think the operation is medically required to persuade an insurance company. It’s worth taking a few extra measures to check if you can have a breast surgery preauthorized to see if your breast lift is covered by insurance.
- Examine your insurance benefits paperwork to check if certain treatments, or breast reductions or lifts in particular, are mentioned. Keep in mind that these policies are often written in legalese, which can be confusing, so calling the insurance company to ask for clarification is usually a good idea.
- If you think your insurance company would cover your breast lift, have your doctor produce a note of medical necessity. Provider offices will typically understand what is required in such a letter and may have previously worked with the insurance company. If necessary, work with your provider to make this procedure easier.
- Find out what documentation your insurance company need for preauthorization by speaking with a caseworker or pre-authorization representative. This is your insurance company’s formal (often written) acknowledgement that it approves services to be done and that it will cover the treatment as long as all preauthorization standards are met.
- Speak with your provider to ensure that the office understands what evidence is required to make good on the claim and that they are prepared to charge it correctly.
- Check to see if the surgeon is part of your insurance plan’s network. Going out of network can result in a loss of coverage or a significant increase in the amount you’ll have to pay.
- Make sure you understand your copay and deductible amounts. Even if the operation is covered, you may still be responsible for a percentage of the cost.
Whether or not your breast lift is covered by insurance, inquire about financial arrangements with your provider’s clinic. You might be able to set up a payment plan, and if you don’t have insurance, see if there are any reductions for paying in full at the time of service.
Does insurance cover breast reduction for back pain?
If you have enormous breasts and suffer from neck, shoulder, or back pain, breast reduction surgery may be a possibility for you. Unfortunately, because this operation is typically deemed elective, insurance companies will most likely refuse to fund it.
Many women cannot afford to pay for breast reduction surgery out of pocket, leaving them with chronic back pain. We at Caliber Pain believe that this regulation is unjust to individuals who have legitimate health concerns about their breast size and shape. These are serious problems that require effective therapy through reduction.
Justifiable Breast Reduction
The good news is that if there is a medical reason, your health insurance carrier may fund breast reduction surgery. A pain management specialist can assist you in gathering a considerable amount of medical data to support your coverage claim.
We understand how and why the size and shape of a woman’s breasts puts pressure on her spine. Many of our patients have degenerative diseases including osteoarthritis, which has been associated to breast proportion. Not every woman with huge breasts will develop chronic pain. However, there is a link between the majority of victims and a smaller frame.
Medical justification is used to determine the outcome of all health insurance claims. Although a breast reduction is strictly a plastic surgery operation, the rationale for the procedure is crucial. A woman who has persistent back pain is unconcerned about her appearance. The goal of treatment is to provide relief from debilitating medical issues.