Am I a Candidate?

How do you determine whether you are a candidate for breast reduction surgery? Commons signs and symptoms which may indicate that breast reduction is right for you.

Am I Candidate for Breast Reduction Surgery?

Overly developed breasts can lead to a number of undesirable health conditions, such as back, neck and shoulder pain, sleeping issues and even skin conditions. Quite apart from the physical challenges, woman with overly large breasts usually face an equally difficult emotional burden. The issues of self-consciousness and insecurity that so often accompany this condition are very real and are usually reason enough to consider breast reduction surgery.

In some cases, breast reduction surgery may be covered in part by your insurance company. However, if your Body Mass Index (BMI) is over 35, breast reduction surgery will not be covered by insurance, and it is not safe to perform. Furthermore, the procedure will only be performed on patients who want to reduce their breasts by a minimum of 2 cup sizes.

For those who do not qualify for breast reduction surgery, a breast lift may be advisable. If you have drooping, sagging, or flattened-out breasts, a breast lift (mastopexy) can give your breasts a more youthful appearance. The procedure can be performed with or without the use of implants, depending on your individual needs and desired results.

Before surgery, our billing team will verify your benefits to see if your insurance covers breast reduction.

If you struggle with the size of your breasts, you are not alone. Every year over 100,000 women plagued with this condition seek out treatment and successfully undergo the plastic surgery procedure known as reduction mammoplasty. If you are considering breast reduction, it is normal to have lots of questions, and our breast reduction surgeons are here to help. Your first question should be: How do I know if breast reduction surgery is right for me?

Symptoms which may indicate that you are a candidate for breast reduction

If you are experiencing one or more of the following symptoms or conditions you may be considered a good candidate for reduction mammoplasty:

  • Breasts that are too large in proportion to one's body size.
  • Back, neck and shoulder pain caused by heavy breasts
  • Grooves in shoulders caused by tight bra straps
  • Poor posture due to breast size
  • Heavy breasts that droop significantly, with downward pointing nipples and areolas
  • Breasts that are not equal in size (one significantly larger than the other)
  • Trouble sleeping due to breast discomfort when lying down
  • Rashes and/or infection affecting the skin trapped beneath one's breasts
  • Inability to participate in athletic/physical activities due to breast size
  • Feelings of self-consciousness regarding breast size

If you regularly experience one or more of these symptoms, a breast reduction may bring tremendous relief. After a breast reduction surgery your breasts will be in correct proportion to your body size. Aside from alleviating uncomfortable symptoms, a breast reduction can enhance the shape and appearance of your breasts and greatly improve the comfort and fit of your clothing.

Breast Reduction and Lift Before & After

Breast Reduction and Lift Before and After

Age: 28, from Los Angeles, California. Patient had back pain and shoulder grooving from her bra straps. Procedure performed was a breast reduction and lift.

See More Before & Afters

"How I feel now, Beautiful! Confident! Everyone here was very professional and listened to my needs! My back used to hurt all the time, and forget about exercising. After my breast reduction surgery was completed I am jogging everyday with no discomfort. I have not felt this good in years." - S. A.

If I am a qualified candidate does that mean my insurance will pay?

When discussing surgery the term "candidate" refers to someone who, based on physical traits, health conditions and other factors, is well suited for a particular surgical procedure. Whether you are a good candidate for breast reduction is something your doctor or surgeon must determine after fully examining your situation as well as studying your medical history. Whether or not your insurance company will cover the procedure is another matter altogether, and one that can be a little confusing at times.

For a breast reduction to be covered by insurance, it must be considered "medically necessary." This is determined using the following chart, which is known as the Schnur Sliding Scale. After calculating your Body Surface Area, look up this number in the left column. The accompanying number in the right hand column is the minimum amount of tissue that must be removed from each breast for a breast reduction to qualify as medically necessary. For example, a Body Surface Area of 1.825-1.849 would mean removing a minimum of about a pound of tissue from each breast (or 461 grams). Less than this, and the procedure will not be covered by insurance.

Body Surface Area Minimum Tissue to Remove,
per Breast (in grams)
1.350-1.374 199
1.375-1.399 208
1.400-1.424 218
1.425-1.449 227
1.450-1.474 238
1.475-1.499 249
1.500-1.524 260
1.525-1.549 272
1.550-1.574 284
1.575-1.599 297
1.600-1.624 310
1.625-1.649 324
1.650-1.674 338
1.675-1.699 354
1.700-1.724 370
1.725-1.749 386
1.750-1.774 404
1.775-1.799 422
1.800-1.824 441
1.825-1.849 461
1.850-1.874 482
1.875-1.899 504
1.900-1.924 527
1.925-1.949 550
1.950-1.974 575
1.975-1.999 601
2.000-2.024 628
2.025-2.049 657
2.050-2.074 687
2.075-2.099 717
2.100-2.124 750
2.125-2.149 784
2.150-2.174 819
2.175-2.199 856
2.200-2.224 895
2.225-2.249 935
2.250-2.274 978
2.275-2.299 1022
2.300-2.324 1068
2.325-2.349 1117
2.350-2.374 1167
2.375-2.399 1219
2.400-2.424 1275
2.425-2.449 1333
2.450-2.474 1393
2.475-2.499 1455
2.500-2.524 1522
2.525-2.549 1590
2.550+ 1662

In order to qualify for partial or full breast reduction insurance coverage, your insurance company must determine that your breast reduction is medically necessary. The tricky part is that the guidelines used to determine this often vary from one insurance company to the next. In some cases there may be slight variations between the different plans offered by the same insurance company. Call today to speak to one of our insurance verification or fill out our insurance verification form and we will get back to you within 24 hours.

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