Does insurance typically cover breast reduction surgery, or is the cost on the patient?

I want to know more about breast reduction surgery. How long does the procedure usually take? Is it in and out, or do I have to stay in the hospital? Would I need to take medications after the surgery? Most importantly, is the nipple still in place or is it also removed? Is the procedure covered by insurance, or is the cost on the patient?

Answers from doctors (3)


More About Doctor Laser Lipo & Vein Center

Published on Jan 20, 2021

Most of the time medical insurance companies do not cover breast reduction as they consider it a cosmetic procedure. However, some medical insurers will cover breast reduction surgery if the breasts are so large that they are causing neck pain or arm pain or similar symptoms and the symptoms are severe enough to be interfering with the quality of life of the woman. The procedure takes an hour or two tops . Open surgical breast reduction makes an incision around the nipple and down the front of the breast. A wedge or skin and breast tissue is removed and sewn back together around the nipple. There is a small chance or nipple loss or loss of nipple sensation. Another option is liposuction, breast reduction this involves small puncture in the skin that usually heal without a scar to remove the fat from the breast. The liposuction, breast reduction does not give as much lift to breast so it not a great option if the breast are really saggy. However, liposuction, breast reduction can be combined with skin tightening with Revuvion or Bodytight to give almost as much lift as an open surgical breast reduction . The combined liposuction breast reduction and has a faster recovery, no scarring and no chance of nipple loss, but it still can not give as much lift to the breast as the open surgical breast reduction.

Answered by Laser Lipo & Vein Center (View Profile)

Most of the time medical insurance companies do not cover breast reduction as they consider it a cosmetic procedure. However, some medical insurers will cover breast reduction surgery if the breasts are so large that they are causing neck pain or arm pain or similar symptoms and the symptoms are severe enough to be interfering with the quality of life of the woman. The procedure takes an hour or two tops . Open surgical breast reduction makes an incision around the nipple and down the front of the breast. A wedge or skin and breast tissue is removed and sewn back together around the nipple. There is a small chance or nipple loss or loss of nipple sensation. Another option is liposuction, breast reduction this involves small puncture in the skin that usually heal without a scar to remove the fat from the breast. The liposuction, breast reduction does not give as much lift to breast so it not a great option if the breast are really saggy. However, liposuction, breast reduction can be combined with skin tightening with Revuvion or Bodytight to give almost as much lift as an open surgical breast reduction . The combined liposuction breast reduction and has a faster recovery, no scarring and no chance of nipple loss, but it still can not give as much lift to the breast as the open surgical breast reduction.

Published on Jul 11, 2012


Edward Domanskis M.D.

Published on Sep 26, 2018

Insurance may cover your breast reduction and really depends on your insurance carrier. We typically take photos or have the patient send them and submit material and documentation to your carrier.

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Answered by Edward Domanskis M.D.

Insurance may cover your breast reduction and really depends on your insurance carrier. We typically take photos or have the patient send them and submit material and documentation to your carrier.

Published on Jul 11, 2012


Insurance coverage of breast reduction is contingent on establishing a case for medical necessity. Patients will typically have documented evidence of neck/back and shoulder pain as well as rashes and bra strap grooving attributable to the increased breast weight. They will often demonstrate that these symptoms have been resistant to more conservative measures like therapy, weight loss, and pharmacologic intervention.

The requirements for reduction will vary from one insurance provider to the next. This may be a standard "500 gm per side" stipulation or a more variable standard based upon body surface area/Schnur scale.

The procedure typically takes 3 hrs (depending on size) and is ambulatory in nature. Patients will typically take perioperative antibiotics and, as needed, narcotic pain medication.

Technically, the procedure is performed by isolating the nipple and areola on a tongue or island of tissue to be preserved. The rest is removed and reshaped, lifting and reducing the breast mound. It may be removed in extreme cases of size and ptosis.

As always, discuss your concerns with a board-certified plastic surgeon (ABPS).

Answered by The Institute of Aesthetic Surgery (View Profile)

Insurance coverage of breast reduction is contingent on establishing a case for medical necessity. Patients will typically have documented evidence of neck/back and shoulder pain as well as rashes and bra strap grooving attributable to the increased breast weight. They will often demonstrate that these symptoms have been resistant to more conservative measures like therapy, weight loss, and pharmacologic intervention.

The requirements for reduction will vary from one insurance provider to the next. This may be a standard "500 gm per side" stipulation or a more variable standard based upon body surface area/Schnur scale.

The procedure typically takes 3 hrs (depending on size) and is ambulatory in nature. Patients will typically take perioperative antibiotics and, as needed, narcotic pain medication.

Technically, the procedure is performed by isolating the nipple and areola on a tongue or island of tissue to be preserved. The rest is removed and reshaped, lifting and reducing the breast mound. It may be removed in extreme cases of size and ptosis.

As always, discuss your concerns with a board-certified plastic surgeon (ABPS).

Published on Jul 11, 2012


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