Breast reduction surgery, called "reduction mammoplasty", is one of the most popular operations performed by Plastic Surgeons. It is a very gratifying operation to perform because the women who have this done are so relieved of pain and happy they have had this procedure. This operation is also popular because it is usually covered by your health insurance carrier. Insurance companies have set certain criteria to be met in order for this to be a covered procedure. Once these criteria have been achieved, coverage is granted in the form of a letter. I have done hundreds of breast reductions and although every insurance company is different, I have found basic prerequisites that all of them want before approving this procedure.

Insurance companies want documentation that the large, heavy breasts are causing significant pain and disability. They will need to see that "conservative" treatments such as anti-inflammatory medications, physical therapy, or chiropractic therapy have been repeatedly tried over a period of several months and have failed. I ask that primary care doctors, chiropractors, physical therapists, and Ob Gyns send letters of support to the insurance company when I send my letter requesting pre-authorization. This strategy has been successful in obtaining coverage but there are other specific criteria that the companies want to see.

It is always helpful to document rashes that occur under the breasts called "intertrigo rashes". These are more common in the Summer months and may require prescription creams. It is also useful to document grooving at the shoulders caused by heavy breasts pulling on bra straps. Insurance companies are going to want an estimate of the weight of breast tissue to be removed and I always include this in my letter to them. They are looking for at least seven hundred grams (slightly less than 2 pounds) off of each breast. Once I complete a consultation and examine the patient I can tell how much tissue by weight should be removed. Pre-operative photographs are taken of the breasts (these do not show the face) and they are submitted to the insurance company with the letter.