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MiladyB

Breast reduction or breast lift covered by insurance

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Hello SocalKelly and WUCRew83

You both ask a very good question. In my experience, insurance does sometimes cover the cost of plastic surgery reconstruction after weight loss, but usually only the abdomen. I have VERY RARELY seen an insurance company cover the arms and thighs, but NEVER the breasts.

Actually my insurance company covered my bilateral maxoplexy. I approached it as a breast reduction instead of a breast lift. My insurance company had an alternate criteria for someone who didn't have the weight in the breast but was still having medical issues.

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Actually my insurance company covered my bilateral maxoplexy. I approached it as a breast reduction instead of a breast lift. My insurance company had an alternate criteria for someone who didn't have the weight in the breast but was still having medical issues.

Hello MiladyB,

Yes you are right. Breast reduction surgery is very commonly an insurance-covered procedure, especially if it causes back, neck and shoulder pain, or rashes beneath the breasts.

If after weight loss, a patient is still having these problems, then insurance will probably cover a breast reduction or lift, provided the medical issues are well-documented.

This is somewhat uncommon, as most of the breast tissue and fat is lost along with the rest of the weight loss after surgery, leaving very little breast tissue behind.

Therefore, by far the most common situation after massive weight loss is saggy breast skin with poor breast tissue volume (and poor projection).

In this case, the best reconstructive procedure would be a combined mastopexy (to correct shape) and breast implants (to correct volume and projection).

This is the procedure I was referring to when I was speaking about poor nsurance coverage for plastic surgery of the breast after weight loss.

I hope that clarifies my earlier answer. Thanks very much for your comments.

Sincerely,

Abhay Gupta, MD.

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Hello MiladyB,

Yes you are right. Breast reduction surgery is very commonly an insurance-covered procedure, especially if it causes back, neck and shoulder pain, or rashes beneath the breasts.

If after weight loss, a patient is still having these problems, then insurance will probably cover a breast reduction or lift, provided the medical issues are well-documented.

This is somewhat uncommon, as most of the breast tissue and fat is lost along with the rest of the weight loss after surgery, leaving very little breast tissue behind.

Therefore, by far the most common situation after massive weight loss is saggy breast skin with poor breast tissue volume (and poor projection).

In this case, the best reconstructive procedure would be a combined mastopexy (to correct shape) and breast implants (to correct volume and projection).

This is the procedure I was referring to when I was speaking about poor nsurance coverage for plastic surgery of the breast after weight loss.

I hope that clarifies my earlier answer. Thanks very much for your comments.

Sincerely,

Abhay Gupta, MD.

Hi, I'm just curious as to what your advice would be to women who are planning on having children later. I'm 27, had WLS April of 2010. I'll be planning to get pregnant within the next year, assuming my surgeon approves. But my biggest complaint is saggy breasts after losing 123lbs and still losing weight. I previously never wanted implants because I don't want to lose the 'natural feel' of my breasts, so I thought I would only want to maybe do a lift. But who knows. I'm also concerned with breast feeding, because I DO want to breast feed my children. So my question is, should I wait to have any kind of plastic surgery on my breasts until after I have children and decide that I'm done having kids?

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Hi, I'm just curious as to what your advice would be to women who are planning on having children later. I'm 27, had WLS April of 2010. I'll be planning to get pregnant within the next year, assuming my surgeon approves. But my biggest complaint is saggy breasts after losing 123lbs and still losing weight. I previously never wanted implants because I don't want to lose the 'natural feel' of my breasts, so I thought I would only want to maybe do a lift. But who knows. I'm also concerned with breast feeding, because I DO want to breast feed my children. So my question is, should I wait to have any kind of plastic surgery on my breasts until after I have children and decide that I'm done having kids?

Hello ashiesteggie,

As you know, pregnancy can have significant effects on breast shape and size, especially if a woman chooses to breast feed.

I therefore usually recommend a patient wait to have any reconstructive or reshaping surgery of the breasts until after they have reached a stable weight and after they are done having kids.

Otherwise, the results of the surgery may be affected by the weight gain and engorgement associated with pregnancy or breast feeding, and you would need to have the surgery repeated.

Hope that helps and thanks again for your question.

Sincerely, Abhay Gupta MD.

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Hi,

Around 8 years ago, I had over the muscle augmentation to enhance my breasts due to age and breast feeding. They were a full C, but have grown and are now DD. Since having them implanted, I have had chronic back pain, neck pain and many other issues. They are very heavy, they have recently started itching on the INSIDE and they sag. Do insurance companies pay for reduction if there are implants involved? I am miserable and need them out, but I don't have the funds. Any information is appreciated.

Thanks!

M

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Hi,

Around 8 years ago, I had over the muscle augmentation to enhance my breasts due to age and breast feeding. They were a full C, but have grown and are now DD. Since having them implanted, I have had chronic back pain, neck pain and many other issues. They are very heavy, they have recently started itching on the INSIDE and they sag. Do insurance companies pay for reduction if there are implants involved? I am miserable and need them out, but I don't have the funds. Any information is appreciated.

Thanks!

M

Hello missysunshine,

Thanks for your question.

Yes, many insurance companies do cover breast reduction surgery, when medically indicated, even if you have implants.

They usually need documentation of back, neck and shoulder pain that is resistant to non-surgical treatments such as weight loss and back therapy.

I would usually recommend either removal or exchange of your implants (to a smaller size) at the same time.

However, the insurance company may not cover the cost of removing or replacing your breast implants.

I recommend you seek consultation with a plastic surgeon, who can discuss the options with you and help submit a claim to your insurance company.

Good luck with everything,

Sincerely, Abhay Gupta, MD.

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After my surgery, my breasts have gotten smaller around but not really in the cup. When I get measured for a bra, multiple places have measured me as a 38DD, but this size never fits. And my right side is noticeably larger than my left. I have a well documented history of back pain and my pcp is definitely on board with me having reduction surgery.

My question is this: Is there a requirement on how much they need to take it down? I've always had a big chest and in ways I feel like I identify with that characteristic. If my breasts end up too small, I'm worried that I would be upset. I would never want to be any smaller than a D cup, but I'm not sure I would even want to be smaller than a perfectly even (on both sides) DD cup.

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After my surgery, my breasts have gotten smaller around but not really in the cup. When I get measured for a bra, multiple places have measured me as a 38DD, but this size never fits. And my right side is noticeably larger than my left. I have a well documented history of back pain and my pcp is definitely on board with me having reduction surgery.

My question is this: Is there a requirement on how much they need to take it down? I've always had a big chest and in ways I feel like I identify with that characteristic. If my breasts end up too small, I'm worried that I would be upset. I would never want to be any smaller than a D cup, but I'm not sure I would even want to be smaller than a perfectly even (on both sides) DD cup.

Hi MaraJayne,

Thanks for your question.

It definitely sounds like you would benefit from a breast reduction to relieve your pain and improve your symmetry.

Almost every insurance company is different in their requirements for breast reduction approval.

Some require a certain weight of tissue removed. Some require a certain ratio of tissue removed to overall body weight or BMI.

Some don't require any documentation of the amount of tissue removed.

If you review your health plan manual, you will probably be able to find the criteria your insurance company requires to approve breast reduction surgery.

Otherwise, your plastic surgeon would be able to help you determine these requirements and submit for insurance authorization of your surgery.

Hope that helps!

Sincerely, Abhay Gupta, MD.

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