Breast Reduction Covered By Insurance

Breast reduction surgery, also known as reduction mammoplasty, is a medical procedure that decreases the size of the breasts by removing excess breast tissue and skin. This procedure is typically performed on women with large breasts that cause physical discomfort, such as back, shoulder, and neck pain, or skin irritation. Some women with large breasts also experience difficulty finding clothes that fit properly or feel self-conscious about their appearance. Breast reduction surgery can help alleviate these issues and improve overall quality of life.While breast reduction surgery is a popular cosmetic procedure, it can also be a medical necessity for some women. In these cases, insurance companies may cover the cost of the procedure. In this article, we will explore the criteria for breast reduction covered by insurance and answer some common questions about the procedure.

Criteria for Breast Reduction Covered by Insurance

To determine if breast reduction surgery is covered by insurance, there are a few factors that need to be considered.

Physical Symptoms

One of the main criteria for breast reduction covered by insurance is the presence of physical symptoms related to large breasts. These symptoms may include:- Back, neck, or shoulder pain- Skin irritation or rashes under the breasts- Chronic headaches- Numbness or tingling in the arms or hands


Insurance companies typically require documentation from a physician to support the need for breast reduction surgery. This may include medical records, photographs, or a letter detailing the patient’s symptoms and how they impact their daily life.

Body Mass Index (BMI)

Insurance companies may also consider a patient’s body mass index (BMI) when determining coverage for breast reduction surgery. Women with a BMI over 30 may be required to lose weight before the surgery can be approved.

Non-Surgical Options

Insurance companies may also require that patients try non-surgical options, such as physical therapy or wearing a supportive bra, before approving breast reduction surgery.

Frequently Asked Questions

Is breast reduction surgery painful?

Breast reduction surgery is typically performed under general anesthesia, so patients do not feel any pain during the procedure. However, there may be some discomfort and soreness in the days and weeks following the surgery as the body heals. Pain medication can be prescribed to manage any discomfort.

What is recovery like after breast reduction surgery?

Recovery after breast reduction surgery typically takes several weeks. Patients will need to avoid strenuous activity, lifting heavy objects, and driving for at least a week after surgery. Compression garments may be worn to reduce swelling and promote healing. Patients may also experience bruising, swelling, and discomfort during this time.

Will insurance cover all costs associated with breast reduction surgery?

While insurance may cover the cost of breast reduction surgery, there may be additional costs that are not covered. These may include anesthesia fees, facility fees, and follow-up appointments. Patients should discuss these potential costs with their insurance provider and surgeon before the procedure.


Breast reduction surgery can be a life-changing procedure for women with large breasts who experience physical discomfort or other issues. While insurance coverage for the procedure may vary, it is important to explore all options and criteria before making a decision. If you are considering breast reduction surgery, speak with your physician and insurance provider to determine if it is the right choice for you.