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 (2)


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 Sep 26, 2018

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 Sep 26, 2018


Answered by The Institute of Aesthetic Surgery

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 Sep 03, 2018

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 Sep 03, 2018


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