Breast Reduction – Does Insurance Cover The Surgery?

Los Alamitos Breast Surgery specialist, Dr. Farbod Esmailian, discusses breast reduction surgery and what are the requirements for the surgery to be covered by your medical insurance.

Breast reduction is a procedure to remove the excess breast tissue and fat, leaving the breast smaller and in a more youthful, lifted position. This procedure is more involved than a breast augmentation, and often takes much longer to perform. Medical insurance may provide coverage of breast reduction surgery if it is shown that the procedure is medically necessary.

Macromastia, or large breasts can cause problems such as neck pain, shoulder pain and grooving from the bra straps, intertrigo rash, and occasionally numbness in the hands. Large breasts can interfere with daily actitivities as well as cause self esteem issues.

Breast reduction surgery may be covered by insurance if the breasts are large enough for the body and the above signs and symptoms are present. To determine what is large for a body, the BSA or body surface area is calculated by measuring the height and weight. A ratio is obtained and this is plugged into a chart which determines how much breast tissue needs to be removed in grams for this procedure to be medically necessary. If all these aspects are met, then breast reduction surgery may be covered by your insurance company.

To determine if you are a candidate for Breast Reduction under insurance, a formal letter would have to be written by Dr. Esmailian to your insurance company after a thorough history and physical exam. To schedule your consultation, you may contact our office by the contact form or simply call 562.655.8071.


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