facebook icon
Rowe Plastic Surgery Logo logo

How to Get a Breast Reduction Covered by Insurance

Home » Uncategorized » How to Get a Breast Reduction Covered by Insurance
Page Updated on May 31, 2022 by Dr. Norman Rowe (Plastic Surgeon) of Rowe Plastic Surgery

How to Get a Breast Reduction Covered by Insurance

Many women want to lift their breasts, have a bigger bosom or fix their sagging bust. Others, maybe including you, suffer with breasts that are so big that they interfere with your life. Super big boobs, clinically called symptomatic macromastia, create a host of uncomfortable complications, including:

  • Chronic shoulder, neck and back pain
  • Rashes and dermatitis underneath your breasts
  • Activity restrictions
  • Nerve pain
  • Poor posture
  • Embarrassment and low self-esteem
  • Breathing problems
  • Skeletal deformities
  • Abscesses and infections
  • Lost feeling in your nipples
  • Fatigue and headaches
  • Sweat gland obstruction
  • Hand pain and numbness
  • Ridges and grooves on your shoulders from the pull of your bra straps

Since macromastia can create these devastating medical conditions, your health insurance company may pay for breast reduction surgery,  called reduction mammaplasty. As you consider getting a breast reduction, be sure to talk with an experienced plastic surgeon who knows the issues surrounding large, droopy breasts and the sometimes-complicated process of getting insurance coverage for breast reduction. In Manhattan, Long Island, New Jersey and the Hamptons, you’re in the best hands at Rowe Plastic Surgery.

What Are the First Steps to Getting Breast Reduction Covered by Insurance?

First, contact your insurance carrier to find out what their particular requirements are to get the procedure covered. While you may know a friend whose breast reduction surgery was fully covered by her insurance, your personal health insurance carrier may have an entirely different set of criteria.

In general, you’ve got to have some proof that you have medical issues from your large breasts. This proof must come from a doctor or medical professional other than your plastic surgeon. In most cases, you must have undergone treatment for anywhere from six to 12 months from providers such as a:

  • Physical therapist
  • Internist or primary care doctor
  • Chiropractor
  • Orthopedist
  • Dermatologist
  • Pulmonologist
  • Rheumatologist
  • Nutritionist

How Do I Know if I Have Enough Documentation?

Chances are that you’ve already talked to your primary care doctor about your various symptoms. Your general practitioner or internist probably referred you to specialists to try to relieve your pain and discomfort. If you haven’t been treated specifically for a condition related to the size of your breasts, ask your primary care doctor to make a referral so you can get the reports you need for your breast reduction insurance.

At Rowe Plastic Surgery, the staff is fluent when it comes to insurance-speak. They can point you in the right direction to get covered for breast reduction surgery. They’ll even help you fill out the required paperwork. Some of the treatments that help you qualify for insurance for breast reduction include:

  • Chiropractic adjustments
  • Prescriptions for a proper bra fitting
  • A weight loss program
  • Pain medications

Is Breast Reduction Surgery Ever Automatically Covered by Insurance?

Some insurance companies only pay insurance for breast reduction in patients over the age of 18. When younger girls experience rapid breast growth, it may be cause for concern and more immediate intervention. The massive and often quick growth may be caused by a reaction to gonadal hormones. While this usually affects adolescent girls, it’s still recommended that you wait until your breasts have completely developed before seeking the surgery.

You won’t need to document a history of trying to relieve symptoms caused by large breasts when your surgery is tied to:

  • Breast reconstruction after a mastectomy
  • Progressive spine issues that don’t resolve with other treatments
  • Intertrigo, which refers to persistent infections under your breasts

When Approved, What’s Included in Breast Reduction Surgery?

Once you’ve completed all the requirements and paperwork to get approval from your insurance company, your cosmetic surgeon explains what you can expect from the surgery. After taking a detailed medical history, your doctor discusses your expectations and takes pictures for before and after comparisons.

Breast reduction surgery is an outpatient procedure that takes one-and-a-half to two hours while you’re under general anesthesia. You’re also given a shot of pain medication that lasts three to five days. Prior to the surgery, you may be asked to undergo some lab tests and get a mammogram to give your doctor a baseline. Steps your Rowe Plastic Surgery team take typically include:

  1. A surgical technique called a lollipop incision relies on fewer incisions, leaving smaller scars. While your insurance doesn’t cover breast reductions for cosmetic reasons, your NJ or NYC plastic surgeon aims to provide you with a natural and more youthful appearance.
  2. Your nipples may remain in place, although usually your areolas are reduced to match your new breast size.
  3. If necessary, your nipples may need to be removed and grafted higher up. They’ll feel just as they did before the surgery once they heal.
  4. Liposuction removes the excess fat in your breasts.
  5. Once the fat and extra glandular tissue are removed, your doctor tightens the skin around your breasts so they better match the rest of your body.
  6. Once the procedure is complete, your breasts are fitted with a drainage tube, if necessary, and wrapped.
  7. Follow-up visits after about six weeks are included in the surgical costs, which are also covered by insurance for breast reduction.

Is Breast Reduction Surgery Worth the Effort?

You have to limit your activities for about a month after surgery, but you can return to work within a week. Other than that, there’s very little downtime. Recovery from breast reduction surgery means avoiding underwire bras, but you may consider that a bonus.

The biggest benefit to going through the surgery approved by your insurance company is that you’ll feel so much better. You may even find that you can participate in sports and exercises that used to be out of your league. You experience no more back aches, neck strains or stiff, marked shoulders. The rash underneath your boobs clears up, never to return. Risks are rare when you rely on experts in breast reduction surgery, but all of them are easily manageable.

Maintain your ideal weight and the results are permanent. To begin the process of getting on your breast surgeon’s schedule, contact Rowe Plastic Surgery today. The staff works with you to determine what steps you need to take to get insurance approval. There’s no reason to wait. Visit the closest office in Manhattan, Plainview or Water Mill, NY or in Montclair or Red Bank, NJ.

Schedule A Free Consultation

*Consult fee for cosmetic services only

Multiple Office Locations