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I am a 40 year old female weighing 168 pounds with a breast size of 40DDD. I am...

Q:

I am a 40 year old female weighing 168 pounds with a breast size of 40DDD. I am seriously considering breast reduction. I have Cigna health insurance and would like to know what are the odds of me getting the insurance company to pay for this procedure for medical reasons and not cosmetic. Because of my large breasts, I get neck pain and have bra indentations on my shoulders. At times I feel uncomfortable when sleeping so I will wear a bra at bed time. Because of the weight of my breasts I am now developing a hunch on my back. My biggest issue is finding the right clothes. I am very top heavy but small on the bottom. I would like my breasts to be proportionate to my bottom frame. Besides wondering if I can get the insurance to pay for the surgery, how small can I make my breasts - can I go down to a size B? What is the difference between a breast reduction and a breast lift? Are there some similarities between the two and what am I looking at in terms of cost if the insurance does not cover the procedure? Thank you for your time.

A:

Breast reduction is usually covered by insurance when the surgery is performed as part of a medically mandated procedure to treat neck, back, or shoulder pain or other problems related to the spine.  Recently, managed care has adopted stricter standards for coverage, so these problems have to be thoroughly documented in writing by your primary care physician and plastic surgeon.  They may also have to submit photographs.  Even then, you may be required to seek a second opinion from a chiropractor, physical therapist, or orthopedic surgeon.

Breast reduction surgery removes excess breast tissue and reshapes the contour of the breasts so that they are smaller and perkier.  I commonly use a minimal incision technique (Le Jour), eliminating the need for large scars while providing a pleasing breast contour and shape that is proportionate to the patient’s body.  This Le Jour technique can now be used on a wide range of sizes and results in a perky, conical breast that many women find desirable.  The resulting incision from this procedure looks like a lollipop with the incision around the areola and down to the fold in the breast.

To perk up a drooping breast, your surgeon will remove excess skin, reposition the nipple, and redrape and tighten the remaining skin to support the breast.  The areola may also be reduced in size.  A mastopexy (breast lift) raises droopy breasts from one to several inches and excess skin is removed.  If you're sagging or asymmetrical, and are looking for perkiness, you'll need a lift - or, if you also want more volume, a lift and implants.

A breast lift raises droopy breasts from one to several inches and excess skin is removed.  If you just want to go bigger, the only way to do that is with implants.  The great thing about these techniques is that they can now be down with minimal scarring and performed as an outpatient procedure without the need for general anesthesia.

When women with saggy breasts want to go bigger, I usually advise doing a breast lift along with the implants.  Otherwise, the implants create what we call a “double bubble,” where the breast droops off the end of the implant like a sock.  Some of my patients, however, don’t want a lift because they want to avoid additional scarring, so sometimes implants alone can fill out the skin and eliminate the saggy appearance.

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