Breast Reduction Size Chart: Determining Medical Necessity
Breast reduction (mammaplasty) is a life-changing surgery that alleviates emotional discomfort and painful physical symptoms for many women. Those who struggle with back pain, neck stiffness, or skin rashes due to heavy, pendulous breasts may also discover their insurance company provides coverage for the surgery. In this blog, we will look at the breast reduction size chart that many insurance companies use to determine whether breast reduction is medically necessary and covered.
What Is a Breast Reduction Size Chart?
A breast reduction size chart identifies how much tissue a doctor needs to remove to relieve a patient’s symptoms directly related to excessively large breasts. The amount of tissue determines whether an insurance company will cover breast reduction surgery.
Surgeons can also use the chart to customize a patient’s surgical plan and predict the outcome. However, if insurance doesn’t cover the procedure, the chart serves more as a guideline for doctors than a strict requirement for surgery.
Understanding the Schnur Sliding Scale
Dr. Paul Schnur developed the Schnur Sliding Scale in 1991 by studying whether women undergoing breast reduction sought the surgery for cosmetic or medical reasons. He found that most patients underwent surgery to treat a medical condition. Since its findings became public, the study has become the primary standard for many insurance companies in determining whether to cover breast reduction.
How Does the Schnur Sliding Scale Work?
The Schnur Scale first determines a patient’s body surface area (BSA) using a calculation based on a woman’s height and weight. The scale then correlates the patient’s BSA with a minimum weight of breast tissue that must be removed to qualify as a medical procedure. This calculation aims to determine whether the surgery is needed to relieve physical symptoms or merely for aesthetic reasons.
Controversy Surrounding the Schnur Scale
Despite the widespread use of the Schnur Sliding Scale, plastic surgeons have raised concerns about the scale’s one-size-fits-all measurement method. Doctors cite the failure of the scale to address the range of symptoms women with exceedingly large breasts often face, such as back strain and the psychological impact of constant unwanted attention. Many patients suffering from the symptoms may fail to seek much-needed relief due to the cost of breast reduction.
Other Factors Influencing Reduction Mammaplasty Coverage Eligibility
Surgeons often combine physical symptoms related to large breasts with the Schnur Scale to determine whether reduction mammaplasty is medically necessary. Symptoms often interfere with daily life and may include:
- Persistent neck, back, and shoulder pain
- Chronic skin rashes and infections
- Pain or numbness in the arms and hands
- Limitations on exercise or other daily activities
Emotional distress is another common side effect of large breasts, but this symptom alone usually doesn’t qualify for insurance coverage. However, psychological issues can support a case for coverage when they are combined with documented physical symptoms and results of the Schnur Scale.
When Will Insurance Cover Breast Reduction?
If you believe you are seeking breast reduction for medical reasons, you and your plastic surgeon can take steps to improve your odds of insurance coverage, including:
- Documenting your symptoms: Maintain a written account of the symptoms you experience, including their frequency and severity.
- Collecting medical records: Records for treatments associated with physical symptoms like back pain and skin conditions can help build your case for coverage.
- Determining tissue removal amount: Using your doctor’s recommendation and the Schnur Scale, determine how much tissue removal will provide the best outcome.
- Checking your insurance plan: Your plan will have specific coverage criteria, so contact your provider to get the details.
- Working with your plastic surgeon: Your surgeon’s office can help you submit a pre-authorization request and an appeal if your request is denied.
Pincus Plastic Surgery is a New York State Health Insurance Program (NYSHIP) provider and an out-of-network (OON) provider. If you have these benefits and your surgery is determined to be medically necessary, your breast reduction should be covered. Dr. Pincus and his staff help eligible patients gain coverage.
Considering Breast Reduction in Smithtown, NY, or Boca Raton, FL?
Dr. David Pincus is a board-certified plastic surgeon specializing in facial and body enhancement. If you are considering breast reduction, Dr. Pincus can help you determine your insurance coverage eligibility based on the Schnur Scale and other factors. To schedule a consultation at our Smithtown or Boca Raton, FL, office, call us today at (631) 352-3556 or complete our online contact form.