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Breast Reduction Surgery: Will Your Insurance Cover The Procedure?

Agnus Smith Published: May 14, 2019 Updated: May 14, 2019

Woman talking with doctor

Altering your body in any way is a difficult and personal decision that Americans face each day, and breast reduction surgery is no exception. For many, reducing the size of their breasts is more than cosmetic, it’s a procedure that may be medically necessary. Which begs the question, is it covered by your health insurance?

What Is Breast Reduction Surgery?

Also known as reduction mammaplasty, breast reduction surgery is a procedure that can be performed only via surgery, and only from a board-certified plastic surgeon. The procedure is meant for those who are seeking to reduce their breast size due to a number of reasons, the most common of which has to do with overly large breasts causing pain, discomfort, or health issues for the individual.

When It’s Medically Necessary

Breast reduction surgery isn’t always medically necessary. For example, there are those who choose to change their look for the sole purpose of self-esteem. While self-esteem and mental wellness are both important to the overall health of an individual, it isn’t always enough to convince insurers to pick up the tab for reduction mammaplasty.

Typically, health insurance companies will only cover the cost of breast reduction surgery if an individual’s enlarged breasts are causing health issues. Below are some of the most common reasons for medically necessary breast reduction procedures:

This can include those who have such large breasts that it causes them breathing issues, especially when they sleep. There are those who have such large breasts that sleeping on their back causes them restricted air movement due to the weight of their breasts pressing down upon their chest and putting pressure on their lungs.

Another, very similar and just as serious reason, would be for those who have too large of breasts for their natural frame and bone structure to hold up. If you are not proportionally built to have such large breasts, it can cause back, bone, and joint issues. Especially on the spine and neck, which can cause major problems that may require surgery down the road.

Safety Concerns & Side Effects

Possible safety concerns of having such a procedure done and the side effects that may follow the surgery are depending on a number of factors. Some of the main possible side effects of having the surgery include the possibility of decreased sensitivity in the breasts, particularly the area of the nipples. The surgery may also potentially alter the individual’s ability to breastfeed in the future, which can be a downside for those who are planning to be pregnant in the future and wish to breastfeed.

The main risk or safety concern for this procedure would be the possibility of an adverse reaction to the anesthesia and the potential for permanent scarring at the incision sites should poor healing occur.

Is The Procedure Covered By Your Health Insurance?

On the subject of whether or not your health insurance provider will cover your breast reduction procedure, this will differ depending on the health insurance company and their breast reduction requirements. There is such a thing as medically necessary breast reduction. However, as a general rule, breast reduction is typically considered a cosmetic procedure.

There is hope, of course, since there are those healthcare providers who are willing to work with patients if they are able to prove to them that their enlarged breasts are causing them health concerns and it is considered medically necessary.

Prior to being able to undergo corrective surgery, a patient will likely need to have attempted to help the issue with other methods. Once those methods prove to not work and they have these attempts recorded with other doctors, then coverage for breast reduction may be more likely to be covered.

Recovery Coverage

As far as how much of a patient’s recovery an insurance provider will cover for a breast reduction procedure, that will also differ depending on their policies and the breast reduction requirements for coverage. Some insurance plans will cover the full cost of recovery after surgery, while others will cover only a certain amount of time spent in a hospital and for medication to help recover once the patient leaves the hospital.

For example, depending on your situation, Aetna may assign a caregiver to aid you in your recovery process once you are home from the hospital. While many major carriers will offer some sort of benefits during your recovery, it’s important to check with your insurance company first, or find a plan that offers the coverage level you need.

How Much It Can Cost You

How much breast reduction surgery will cost you will differ, not only on your health insurance provider but also on what doctor you go to and in what state of the US you are in. The averages will be much higher in more largely populated cities versus if you were to seek a procedure from a doctor located in a more rural state.

Prices will be different, but the national average for a breast reduction procedure itself (not including hospital stays or anesthesia costs) is around $7,000 - $8,000 out-of-pocket before insurance is applied. Again, that price may be different based on your coverage level and out-of-pocket maximum.

Find Breast Reduction Surgery Coverage With FirstQuote Health

If you’re unhappy with your coverage or feel that it doesn’t do enough to cover your breast reduction procedure, then FirstQuote Health can help. With a uniquely accurate quoting engine that we’ve developed, FirstQuote Health has helped countless people just like you find and compare health insurance quotes in their area. Getting started is as easy as entering your zip code and answering a handful of questions.