Does UMR Insurance Cover Breast Reduction?

Cosmetic procedures are not covered by UnitedHealthcare, including but not limited to: • Breast reduction surgery performed to improve appearance without addressing a functional or physiologic limitation. Breast reduction surgery with only liposuction as a treatment.

Does UMR cover breast augmentation?

Exclusions and Limitations of Coverage Cosmetic Procedures are not covered by UnitedHealthcare, including but not limited to the following: Following a cosmetic breast augmentation, you may need breast prosthesis or replacement.

How big do your breasts need to be to get a 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.

Is breast reduction surgery painful?

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 long is the recovery for breast reduction?

Because every patient reacts to surgery differently, it’s difficult to say how long you’ll be out of commission after this procedure. You’ll need between two and six weeks to fully recover, though you’ll notice a difference in strength and vitality after around seven days. Depending on the nature of your employment, you’ll probably require at least a week off, and you’ll have to limit your activities during that time.

This means you’ll require assistance with meal preparation, housework, kid care, shopping, and even self-care. Furthermore, we advise you not to drive until you are able to comfortably use a seatbelt. This can take between one and three weeks, so plan accordingly for your kids and your personal appointments and needs.

Is breast asymmetry covered by insurance?

  • Several breast surgeries performed at The Sayah Institute may be eligible for insurance reimbursement or payment:
  • Asymmetrical Breasts: Although all women have some degree of asymmetry between their breasts, excessive examples may necessitate surgery. Insurance may reimburse an aesthetic breast treatment performed to correct a considerable degree of asymmetry.
  • Although not all breast lumps are cancerous, they may nonetheless necessitate a full or partial mastectomy or lumpectomy, as well as reconstructive breast surgery.
  • Women who test positive for the BRCA1 or BRCA2 gene may choose for a prophylactic mastectomy to reduce their risk of getting breast cancer. A preventative mastectomy should leave more optimal scars when performed by a board certified plastic surgeon.
  • Breast Implant Complications: Insurance generally covers revision surgery for implants that have changed in location, ruptured or leaked, or other complications associated to breast implants.
  • Insurance companies that cover the costs of a primary operation are also required to cover the costs of reconstructive breast surgery after a mastectomy or lumpectomy. This could entail implant restoration, flap reconstruction, or other procedures to restore breast symmetry.
  • Breast Reduction: Because macromastia, or the condition of having very large breasts, can result in a multitude of secondary health issues such as back and neck pain, breast reduction is largely a medical treatment rather than an aesthetic technique.
  • Capsular Contracture: Scar tissue growth around breast implants is a typical component of the body’s healing process. An expansion of scar tissue, on the other hand, might feel rigid or even painful, and it can also cause implant displacement. The scar tissue capsule is loosened or eliminated during breast revision surgery for a beautiful, natural look.
  • Congenital Abnormalities: Congenital deformities can be mitigated or rectified by reconstructive breast surgery, whether they are present from birth or only become obvious during puberty.
  • Gynecomastia is the growth of male breasts caused by a hormonal imbalance, which usually occurs during puberty.
  • Male breast reduction removes extra glandular and fatty breast tissue to display greater muscle definition and corrects the look of gynecomastia.
  • Inverted Nipples: Nipples may be inverted from birth or develop over time as a result of breastfeeding issues, ptosis (droopy breasts), or physical trauma to the breast. Both men and women can have their nipples retracted through surgery, which is usually done as an outpatient operation.
  • Tubular Breasts: Tissue constriction during breast development in adolescence can cause breasts to seem tuberous. This tightness can be loosened and adjusted for a rounder, softer shape, either with or without implants, with the right surgical method.

Do you have any other concerns about your insurance coverage? The Sayah Institute can be reached at

Is breast reconstructive surgery covered by insurance?

Breast reconstruction operations should be covered by your health insurance plan whether they are performed immediately after a mastectomy/lumpectomy or several years afterwards. Procedures to improve the reconstructed breast and/or produce symmetry (balance) between the two breasts may be required over time.

All group health plans that pay for mastectomy must also cover prosthesis and reconstructive operations, according to the Women’s Health and Cancer Rights Act of 1998. Furthermore, Medicare covers breast reconstruction, although Medicaid coverage varies by state. You should check with your plan administrator because government and church-sponsored plans are not always obligated to cover rehabilitation.

Even if you’re insured, complications can arise, particularly in certain situations: for example, if you’ve chosen a newer form of reconstructive treatment, if you’re undergoing surgery to create a more balanced appearance, or if you require a thorough repair of a previous reconstruction. If you want to see a plastic surgeon who isn’t in your health insurance plan’s network, coverage can be a problem.

It’s usually advisable to check with your health insurance carrier ahead of time to see what’s covered so you don’t have to deal with the hassle of attempting to collect payment later. You can also work with the insurance claims administrator at your plastic surgeon’s office. Your state’s health insurance agency and commissioner are another potential resource, as several jurisdictions have implemented new legislation requiring coverage for breast reconstruction.

Here are some questions to ask your insurance company and the cosmetic surgeon’s office to help you get started:

  • Is a mastectomy covered by my insurance? (It must cover reconstruction if the answer is yes.)
  • What expenses will be covered if I travel to another surgeon who specializes in a method that isn’t available in my network?

The Breast Reconstruction Guidebook, by Kathy Steligo (Baltimore: The Johns Hopkins University Press, 2017), pp. 207-208.

Remember that your deductible and co-pays will still be your responsibility, so be sure you know how much you’ll be spending out of pocket. If you’re accountable for a portion of the treatment costs, it may impact your choice of reconstruction. Although prices vary, implant operations are generally less expensive than tissue flaps. They are, however, more likely to require change in the future, so the total cost may be equal.

According to Frank J. DellaCroce, M.D., FACS, plastic surgeon and co-founder of the Center for Restorative Breast Surgery, how your plastic surgeon’s office interacts with your insurance company regarding your surgery can make a big difference. The office must utilize wording that makes it obvious that the procedure is medically required rather than merely aesthetic. “If you’re repairing a rebuilt breast that has gotten deformed, for example, or balancing the two breasts, the insurance plan may deny reimbursement right away, claiming, “Well, that’s cosmetic.” Instead, we might have to state, “After mastectomy, she had asymmetry in the breast that caused a cup size discrepancy that made apparel and function problematic, and she has an overall imbalance that is developing a symmetry deformity.” When you set things out like way, it’s tougher for them to respond, “Well, too bad.” It starts to feel more real.”

  • Make sure the office is utilizing the ICD-9 (soon to be ICD-10) code, which is the standard classification system that all insurance companies follow.
  • Don’t give up. If your claim is refused, you and your doctor can amend the description and send a non-identifying photo (of your chest just, not your face) to show the issue area (s).
  • As you move on with your case, keep comprehensive paper records of all communications.

“We normally have success,” Dr. DellaCroce says, “but the way the physician’s office conveys the issue to the insurer will either ensure coverage or guarantee denial.”

Our blog, Reconstruction Coverage Under the Women’s Health and Cancer Rights Act, is also worth reading.

Is cosmetic surgery covered by insurance?

However, because these procedures are mainly elective, most health insurance policies do not cover them. Furthermore, because plastic surgeries are not considered important medical treatments that are performed to save a person’s life, they are not covered by any health insurance.

Does your stomach look bigger after breast reduction?

Breast reduction surgery can promote weight gain, according to a popular belief among Beverly Hills women. The truth is that perception differs greatly from reality. The basic answer is that there is no link between breast reduction surgery and increased weight. Breast reduction has a direct impact on a woman’s overall proportions, and it can appear as if she has gained weight as a result of the procedure. A woman’s torso and hips appear smaller when her breasts are larger. When breasts are reduced, the hips and torso can appear to be larger. It’s worth noting that the proportions of the breasts, hips, torso, and waist have fundamentally changed after breast reduction surgery.

In fact, many women lose weight after having their breasts reduced in Beverly Hills.

This is due to the surgery relieving strain on the neck and back, allowing patients to engage in more physical activity.

Women with excessively big breasts are frequently obliged to reduce their physical activities due to neck and back pain.

Breast reduction in Beverly Hills removes the excess tissue and weight of the breasts, allowing women to become considerably more active.

Women may notice a difference in their posture after having their breasts reduced.

Because the pressure on the neck and back is relieved, women’s posture frequently improves after surgery, allowing them to stand higher.

This allows them to keep their shoulders up and back, preventing the “hunched-over” impression that many women with enormous breasts suffer from.

Because the main culprit is dimensions, which can make women feel as if they’ve gained weight following the treatment, some women choose for further plastic surgery procedures to improve their overall appearance.

A stomach tuck and liposuction are two operations that can be used to create a smaller, firmer torso.

In many circumstances, these treatments can be done at the same time to yield incredible outcomes in a single therapy.

Schedule a consultation with Dr. Raffi Hovsepian if you’re thinking about breast reduction surgery but aren’t sure if the proportions will make you look heavier.

He talks with each patient one-on-one to assess any unique conditions that may have an impact on the final outcome.

What are the symptoms of needing a breast reduction?

According to the American Society of Cosmetic Surgeons, breast augmentation is the most popular surgical operation, but breast reduction, another plastic surgery procedure that modifies the breasts, can have equally life-changing benefits for those who require it. Although it may appear that everyone is wanting to grow their breasts bigger, women with huge breasts frequently suffer from physical and emotional anguish as a result of their breasts. Women with enormous breasts, especially those that droop and hang, suffer from physical and emotional problems such as neck, shoulder, and back pain, low self-esteem, and a lifetime of suffering. People without large breasts may find it difficult to understand that having a huge breast may affect your daily life, yet ladies with large breasts will tell you about their difficulties exercising, sleeping, and more. Breast reduction surgery allows women with enormous breasts to eliminate the pain and inconvenient aspects of their figures, but many women are unaware of the signs that suggest the necessity for surgery.

What are the symptoms of needing a breast reduction?

Breast reductions are done for a variety of reasons, including physical and emotional discomfort. Breast reduction surgery may be beneficial if you are experiencing any of the following symptoms as a result of your large breasts:

Several of these symptoms are common in women with big breasts. Some health insurance companies may cover the cost of breast reduction surgery depending on the severity of the problems.

What are the benefits of breast reduction surgery?

The weight of a patient’s enormous breasts can be both actual and symbolic. Daily tasks such as exercise, sitting straight, and sleeping can be difficult or impossible. Breast reduction surgery relieves a lot of the physical pain that comes with having large breasts, such as back, neck, and shoulder pain, as well as discomfort while exercising and shoulder grooves. Many women report feeling more confident about their bodies and wearing specific ensembles in public as a result of breast reduction surgery, and this boost in confidence is a significant emotional benefit. Breast reduction surgery also has a number of cosmetic advantages, including:

Finding stylish and comfy bras, swimwear, sports bras, and clothes is simple.

Who is a good candidate for a breast reduction?

Women who suffer from the physical pain or emotional symptoms linked with large breasts and desire to alleviate these concerns are the greatest candidates for breast reduction. Breast reduction surgery can be done at any age, but teenagers who undergo it before their breasts have fully matured may require a second procedure later. Breast reduction surgery should be postponed for women who are expecting to have children until after their last pregnancy, as breasts grow and shrink during pregnancy, and breast reduction may affect a woman’s ability to nurse. Breast reduction surgery should be postponed for women who plan to lose a large amount of weight, as weight loss can alter the size and contour of the breasts. Breast reduction surgery should be avoided by patients who smoke, have specific medical conditions such as diabetes or heart disease, are extremely obese, or do not want scars on their breasts.