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.
How can 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.
Where does your back hurt if you need a breast reduction?
Help is available if you are experiencing neck or upper back pain as a result of your large breasts. There’s no need to suffer from back pain as a result of having huge breasts.
Upper back pain therapy options include everything from lifestyle modifications to drugs to surgery in severe circumstances. You could consider trying:
- Sports bras and customized bras These bras can assist disperse and support the weight of enormous breasts since they are carefully constructed especially for women with narrow backs, who have a more concentrated distribution of weight than those with wider backs.
- Physical treatment and exercise are recommended. Working with a therapist or personal trainer can help women who are overweight or obese improve their posture and lose weight.
- Medication. When upper back discomfort strikes, taking an over-the-counter pain treatment (such as ibuprofen or aspirin) is perfectly acceptable. In addition, your doctor may prescribe stronger medicine to help you “get over the hump” of the more acute pain that comes with having huge breasts. Keep in mind, however, that medications are not intended to be a long-term treatment for back pain caused by large breasts.
- Breast reduction surgery is a procedure that reduces the size of the breast Breast reduction surgery is frequently suggested to women who suffer from upper back pain caused by big breasts. It may be the only method to permanently treat the problem. According to research released by the American Society of Plastic Surgeons, half of 179 women with breasts size DD or larger experienced practically continual upper back pain or pain in their necks, shoulders, or lower backs prior to breast reduction surgery. Only 10% of women experienced these problems after the procedure.
Bottom line: Consult your doctor if you’re experiencing upper back pain as a result of your huge breasts. You can put together a plan that will work for you if you work together.
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 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 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.
Can large breasts cause lower back pain?
When it comes to women and back pain, most people think of the usual suspects: injuries or accidents, physical labor, active sports lifestyles, and other things that commonly cause back pain in men and women. However, there is one concern that only women face: breast size. Headaches, posture troubles, neck pain, upper and lower back pain, and even physical abnormalities caused by overloaded bra straps can all be caused by large breasts.
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 prove I need a breast reduction?
Although most women choose mammoplasty to relieve pain and achieve a more proportionate breast size, there are various other aspects to consider, including