Dr. Pane explains both the medical and insurance perspectives on breast reduction procedures.

Ask Dr. Pane: Requirements for Breast Reduction

Atlantic Coast Aesthetics deals with a lot of patients who are concerned about breast reduction procedures. Patients want this type of procedure for a number of reasons, and not all of them involve what most people would call “vanity.” One of our viewers asked, “I’m 34DDD and I know that that isn’t entirely huge but I’m wondering what the requirements are for breast reduction? Would that help the saggyness or would just an areola reduction (I HATE mine and get really depressed and insecure about them) and breast lift help perk them up?” Dr. Pane chose to address this question mainly because it is such a common one among women with larger busts.

Insurance versus self-paid?

Dr. Pane noted that the question isn’t particularly clear as to whether insurance or the patient will be paying. This can directly impact the probability of getting the procedure, because although breast reduction is almost as common as its counterpart, augmentation, some insurance providers may be reluctant to pay for breast reduction without a “medically necessary” reason. Because of the ambiguity of the question, therefore, Dr. Pane elected to address this question from both sides.

Insurance, the bottom line and breast reduction:

One reason why many insurance carriers balk at paying for breast reductions is because there is a perception that what the carrier is really paying for is a medically unnecessary breast lift, which although a component of breast reduction is in these cases usually just a finishing touch to adjust the bustline so it will be firmer and more aesthetically pleasing.  Dr. Pane notes that insurance carriers do not have any hard and fast universal rules regarding what does and does not constitute “medically necessary” breast reductions. However, the following criteria are often a good starting point:
Extreme sagging of the breast tissue, such that it impacts the patient’s daily life activities.
Back pain arising from and directly attributable to the size of the breasts.
Heaviness, pulling or rash beneath the skin of the breast tissue.
Because of the rising deductibles attached to all forms of medical care, not just cosmetic surgery, patients may find that it is more difficult to persuade their insurance carriers that a breast reduction is in fact a reasonable solution to the problems that outsized breasts can cause.

The medical argument for breast reduction

In contrast to the insurance perspective, Dr. Pane points out that many patients do need breast reduction procedures to correct sagging, an unpleasing contour and even lower back pain. Many carriers are suspicious of a “bait and switch” wherein a patient goes in to have procedure X done and comes out with procedure Y, causing them to balk at these procedures. There is an inverse correlation between breast size and the anticipated difficulty one can expect from their insurance provider, or to put it another way, the larger the breasts, the less difficulty one can expect and vice versa.

What should I do?

Dr. Pane suggests that patients whose insurance carriers refuse to cover the procedure work on a cash basis. In some cases, patients may be able to finance the procedure through a medical financing and credit company and then seek reimbursement from the insurance carrier at a later date. While this is not the ideal solution for most patients, it is important to note that the longer these issues go uncorrected, the more likely it is that the patient will have to live with the aftereffects for the rest of their lives.

How do I know if breast reduction is the right choice for me?

Generally, your body will tell you if your breasts are too large or if something else is wrong. Discomfort and pain are the body’s warning signals that something is not right, and people who ignore these signals when they first begin often come to regret it later. If you are unsure or on the fence about whether you should consider breast reduction, a direct clinical evaluation can help determine what other options may exist for correcting the issue, including surgical and nonsurgical treatments and intervention. However, you know your body best, and it’s important to listen to what it is telling you. If you think your breasts are too large, and especially if you’re experiencing physical discomfort because of them, you are probably right and should at least look into the available options.
If you or someone you know has questions or concerns about cosmetic surgery, we at Atlantic Coast Aesthetics are always happy to discuss the topics that you’re most interested in. Simply call us at (561) 422-4116, email us at http://acplasticsurg.com or follow us on Twitter and Facebook! Your question could help Dr. Pane help and educate others as ACA’s next “Ask Dr. Pane” segment, answered live in an upcoming Google Hangout. Remember, we believe the only bad question is the one you don’t ask!

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