Is a breast reduction a medical necessity?

Q:

I have been large breasted from my early teens on up to my current age. My weight has gone up and down, my lowest ever weight was 125 pounds with no significant reduction in the size of my breasts. They are so heavy they ache when I remove my bra. There are times when I have sharp pains in the tissue of the breast not due to my menstrual cycle. No amount of support from a bra will keep me from sweating and getting boils and infected pores under the breast from which a white puss drainage can be squeezed out. Is a breast reduction a medical necessity?

A:

Dawn,

 

 This a common & great question. Medical Necessity is term developed by the Insurance Industry. In todays world the Insurance Industry dictates health care not doctors or surgeons because, they say they are the ones eventually paying most of a patients bills. Each insurance plan is different and often related to the cost of the plan. It is best to think of them like cars. Some are Dodge Neons, others a Subaru and some Cadillacs. The better the plan often requires more cost to the patient/ consumer.

 If you have insurance check with your carrier to see if they even will cover Breast Reduction Surgery. Some do not. Then, ask for the criteria's for coverage of the Breast Reduction Surgery. This are the conditions/ symptoms that a patient must have for the insurance company to deem that the Breast Reduction would be a covered service. Lastly, ask for a list of plastic surgeons in your area that take your insurance.

 Hope this is of assistance. 

Best,

 

Gary R Culbertson, MD, FACS

A:

Yes, your type of condition is often covered by your medical insurance.  You have infection, ect. and this can cause ongoing medical problems.  You did not say your  breast size  but i assume that you breast are larger than DD.  The next step is to call your insurance company to determine your benefits and what plastic surgeons are on the panel at the insurance company.  A consultation you will find very informative and can help you go through the process.  Good Luck.

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