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 do I prove I need a breast reduction?
While you may just believe that your breasts are too huge and that having smaller breasts would make you look and feel better, these are only a few of the factors to consider when considering breast reduction surgery. There are a few more highly essential symptoms to keep in mind.
- The grooves in the tops of your shoulders caused by your bra straps.
- Breasts that droop as a result of weight gain, causing your nipples and areolas to point downward.
- Because of the size/weight of your breasts, you are unable to participate in sports or other physical activities.
How much does a DD 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.
Does insurance pay for breast reduction due to 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.
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 a size C breast weigh?
3 bananas for each knocker This fruity delight, which is high in potassium, wouldn’t last one elbow to the chest in a crowded store; picture the mess. However, the next time you go to the shop to get some, keep in mind that you’ll be carrying them around with you all the time.
Sweater Stretchers, the musical, is a 25-hour cinema reel. From beginning to end, a 25-hour basket of emotions. We’d keep an eye on it just to see how many times we’d actually worn a bra for a week without washing it, though after the 500th time it could become awkward.