Can a breast reduction be covered by insurance?

Are you tired of carrying around two bowling balls on your chest? Do you experience back pain, shoulder grooves from bra straps, or difficulty finding clothing that fits properly? If so, a breast reduction surgery may be just what the doctor ordered. The only problem is whether or not your insurance will cover it. In this article, we will explore the various factors involved in determining if a breast reduction can be covered by insurance.

First things first: What is a Breast Reduction Surgery?

Before diving into the nitty-gritty details of whether insurance covers a boob job (that isn’t actually making them bigger), let’s take some time to talk about what exactly happens during this surgery. A breast reduction involves removing excess tissues and fat from the breasts while lifting and reshaping them to create less strain on shoulders and necks resulting in improved posture – essentially decreasing their size. This procedure helps individuals who suffer from large breasts and all unwanted associated symptoms.

Despite being identified with different names such as mammoplasty, reductive mammaplasty, among others; they aim at achieving similar results which are improved overall wellbeing through decreased risks of injury sustained because of heavy/oversized breasts.

Risks Associated With Breast Reduction Surgery

In every surgical procedure comes along numerous health risks but there are certain notable ones specific to mastectomy:

  • Excessive bleeding
  • Adverse reactions brought about by anesthesia
  • Infection
  • Sensitive nipples or loss thereof
  • Scarring

It is always essential to carefully discuss potential risks before concluding any medical undertaking regardless its nature.

Insurance Coverage for Prospective Patients

So here’s the million-dollar question: does insurance cover costs surrounding such procedures?? The answer lies behind multiple prerequisites set forth fully depending on peculiar classifications established by insurers.

Some prerequisites stands out irrespective of classification undertaken including documentation highlighting persistent medical problems caused by large or unusually shaped breasts. It is beneficial to mention some underlying conditions that insurers may consider as justification for further proceedings, namely:

  • Inflammation beneath the breast area
  • Limited exercise regime due to excessive chest weight
  • Posture issues caused by heavy breasts leading to headaches

With qualification criteria exceeded and a recording of medical history submitted, your insurance company would decide whether surgical procedures are classified as elective surgery. Elective surgeries fall under categories whereby patients undergo operations not deemed medically necessary.

Additional Prerequisites

Good news…more prerequisites wait for you in line! As a prospective patient undergoing such surgery with any intentions of claiming insurance support at all junctures it pays to ensure fully heeding additional set directives in efforts towards achieving your medical goals. Thus include:

Obtaining Precertification from Insurer

To ascertain which providers cover these procedures within their terms extend far beyond personal telephone conversations with employees only licensed physician can help determine whether these requirements have been met but it’s important we note every insurer has its unique guidelines on what are acceptable standards.

Breast Reduction Criteria

While determining this criterion many based upon health-related factors others arises through aesthetic considerations meaning successful approval shall be realized in acquiring support from both ends.

Breast reduction eligibility includes maintaining body mass while also ensuring preoperative measurements gets attained (over 500 gm) since anything other than that will get recognizable cosmetically rather then appreciating physiological benefits accruing attendant risk amid few likely available options.

Additional factors carefully scrutinized alongside weight measurement comprise the following (but not entirely limited):

  1. Cup size:Inadequate activity resulting from pressure off significantly sized breasts.
    2.Postural difficulties occasioned uniquely in women who feel strain brought about big-breastedness causing prolonged migraine periods.
    3.Excoriation or rash unfolding underneath skin folds emanating directly due friction impacted specifically individuals whose bra cups run deep known culprits typically measuring above D.

It is worthy noting that the health benefits clocked from breast reductions outweigh all potential risks.To say it’s worth it would be an understatement.


Let us summarize what we discovered in this entertaining and informative article: whether or not your insurance will cover a breast reduction surgery depends on numerous factors, including medical necessity versus cosmetic purposes. A crucial point to note is that even when approved procedures could result in functional well-being positively affecting overall health. We advise our readers to consult with their doctors regarding eligibility for breast reduction obtaining approval from respective insurers.Subjectivity remains the key difficulty while deciding over which directive pre requisites should adhere ranging from cup size variations down body mass percentages scrutinized towards realigning security measures taken whilst evaluating these requirements extend beyond personal interactions engaging experts solely specifying certain details relevant.

So why wait? If you suffer from back pains or shoulder grooves as a result of considerably large breasts schedule appointment today with physicians making sure everything insurance wise ticks off then rest easy knowing every pain goes away!

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