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Is Breast Reduction Surgery Right For You?

Learn the risks and benefits—and how insurance companies make their coverage decisions.

Photo credit: Getty Images

Look and feel your best.

Dear Doctor,

I’m 38 years old, and ever since I was a teenager, I’ve been very self-conscious about my large breasts. After two pregnancies, they’ve gotten even bigger, and I now have a lot of back and shoulder pain. I’m thinking about having breast reduction surgery, but I’m worried about the scars. I’m also worried about paying for it if insurance doesn’t cover it. What do I need to know?


“Tired of Being Top Heavy”

Dear Tired:

Breast reduction surgery is often the best option for women with large breasts, and I’ve had many patients who have been extremely happy with their decision to have this surgery. It has eliminated their chronic back and neck pain, and enabled them to exercise easier and have better posture.

But there are some important factors you need to keep in mind if you’re considering this procedure. First, you are right that you will have scars and those scars are permanent. In addition to a scar around the areola and a vertical scar underneath the areola, you might also have a horizontal scar underneath the breast. In some patients, the scars fade somewhat, and in others, they remain discolored and slightly raised.

The surgery is done under general anesthesia, but most patients are able to go home the same day. You’ll feel a little uncomfortable for the first two or three days, but many patients say they immediately feel better with less weight on their necks and backs. By three weeks, you should be fully recovered, which is when you can resume your normal activities. I also recommend that women wear a bra 24 hours a day for the first four to eight weeks.

There are also some potential complications associated with breast reduction surgery. You could lose nipple sensation, nipple projection, and in some cases, nipple color. If you plan to have more children, you might lose the ability to breastfeed.

You should also know that breast reduction surgery is not the same as a breast lift, which is a cosmetic procedure that raises the breasts by tightening the surrounding tissue and removing excess skin, creating a lifted, more youthful appearance; that procedure is not covered by insurance. With a breast reduction, they won’t hang down as far, but you’re not going to end up with breasts that look like an 18-year-old’s, either.

Another key point I like to stress to patients is that insurance companies are getting very strict about the rules for covering breast reduction surgery. If someone just wants their breasts to look better and they aren’t having any physical problems—like back, neck or shoulder pain—then the surgery is not covered by insurance.

To be covered, you need documentation from a medical professional that you have back, shoulder or neck pain that may be related to heavy breasts. This means a note from a chiropractor, physical therapist, orthopedic surgeon or internist that you have tried all kinds of conservative treatments which have failed. Or, your insurance may cover the surgery if you have a note from your dermatologist that you have chronic rashes under your breasts that can’t be cured with other treatments.

The other thing that insurance companies do is dictate the minimum amount of reduction that needs to occur for the procedure to be considered medically necessary. There’s a scale that they use based on your body surface area to determine how much breast tissue needs to be removed from each breast. What this means for patients is that I can’t guarantee I can make their breasts whatever size they want. If someone with a DD wants to be a C, I have to tell her that I can’t guarantee that, and she may end up being smaller. Many women are fine with this, because they are just so relieved that they don’t have chronic pain anymore.

All in all, when done for the right reasons, breast reduction surgery can be a great option.

“If someone just wants their breasts to look better and they aren’t having any physical problems—like back, neck or shoulder pain—then the surgery is not covered by insurance.”
Dr. Armen Kasabian, plastic surgeon
Dr. Armen Kasabian, plastic surgeon | Photo credit: The Well

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Published October 2nd, 2018

Look and feel your best.