Breast reduction, or reduction mammaplasty, is the surgical removal of excess breast tissue, fat and skin to reduce the size of the breasts. Many people get breast reduction for cosmetic reasons to achieve a more proportional body shape, but there are medical conditions that require breast reduction for health reasons. In these cases insurance may cover the procedure. The breast reduction cost can vary based on factors such as the type of procedure, the surgeon's experience, and additional costs like anesthesia and medications. This article will look at what breast reduction is covered by insurance and who is eligible.
Large breasts can cause a multitude of medical problems that affect daily life. These problems make breast reduction medically necessary and therefore eligible for insurance coverage. Some of the conditions that may require a medically necessary breast reduction are:
Large breasts can cause chronic pain in many areas of the body including:
The weight of large breasts can strain the upper and lower back causing chronic back pain and discomfort.
The constant pull of heavy breasts can cause neck strain and tension headaches.
The weight can cause grooves in the shoulders from bra straps contributing to shoulder pain and even nerve compression.
Excess breast tissue can cause skin problems such as:
A rash that occurs in the skin folds beneath the breasts often leading to fungal or bacterial infections.
Constant friction between the skin and bra can cause painful chafing and sores.
Moisture trapped under the breasts can lead to persistent skin infections and irritation.
The weight of large breasts can cause posture problems including:
Over time poor posture can contribute to spinal issues such as kyphosis (curvature of the upper spine).
Poor posture can also lead to musculoskeletal problems affecting overall body alignment and function.
Large breasts can make physical activities difficult to do and can't be exercised. This can lead to:
For health insurance to cover breast reduction surgery the following criteria must be met. These can vary between insurance providers but generally include:
Health insurance plans often require specific documentation to prove the medical necessity of the surgery. This includes detailed medical records, a history of chronic health symptoms, and a recommendation from a healthcare provider.
Insurance companies need thorough documentation to prove medical necessity of the procedure. This documentation may include:
Insurance companies have guidelines on the amount of breast tissue removed for the procedure to be medically necessary. This is usually measured in grams and can vary based on the patient's body size and health status.
Documentation should also include the impact of large breasts on the patient's daily life including:
Breast reduction surgery involves several steps to achieve the best results. Here's what to expect: Patients should be aware that breast reduction scars are a common complication. These scars typically appear as thin lines that will fade over time.
The process starts with a consultation and exam by a board-certified plastic surgeon. During this consultation the surgeon will:
Before surgery you will be given specific instructions to follow. This may include:
Breast reduction surgery is done under general anesthesia and involves the following steps:
Recovery time will vary from patient to patient but here's what to expect:
Post-surgery care is crucial for successful breast reductions, and it's important to address common questions patients may have about the procedure.
As with any surgery, breast reduction surgery has risks and complications. These may include:
Choosing the right plastic surgeon for your breast reduction is key to achieving the best possible results, medically and aesthetically. Here's why New Jersey Plastic Surgery:
We perform these surgeries at Premier Surgical, a AAAASF accredited facility.
The insurance approval process for breast reduction surgery can be complicated. Here's what to expect:
Breast reduction surgery can be life changing for those with medical conditions caused by large, heavy breasts. Knowing what is covered by insurance and going through the approval process will help you get the best results. Cosmetic breast reduction is not covered by insurance, medically necessary breast reduction is. If you think you may be a candidate for medically necessary breast reduction, talk to a qualified plastic surgeon to learn more and start your journey to better health and happiness. For more information or to schedule a consultation, contact us today.
New Jersey Plastic Surgery 29 Park St, Montclair, NJ 07042
Our New Jersey Plastic Surgery cosmetic specialists are ready to help you achieve your aesthetic goals with the most advanced treatments the cosmetic industry has to offer. Contact us today to take your first step toward a more beautiful you.
