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April 17, 2024


When Is a Breast Reduction Medically Necessary?

A woman cradles her large breasts to alleviate pain.

There are several reasons a breast reduction may be desired, including personal preference, unwanted attention, and discomfort. When chronic neck, shoulder, and back pain are involved, patients may meet the criteria to qualify for this surgery as a medically necessary procedure. In these cases, some health insurance policies may pay for a portion of the costs. This blog will review the how, what, where, and whys that justify such a classification and when insurance may cover breast reduction.

5 Min Read:

How Can Breast Reduction Be Considered a Necessity?

Sometimes, what you need and want can be the same thing. Breast reduction surgery, also known as reduction mammaplasty, is not sought solely for cosmetic reasons. In many cases, this procedure is deemed medically necessary due to a variety of physical and psychological concerns associated with large, heavy breasts. While breast reduction surgery offers obvious aesthetic benefits, its medical necessity is often rooted in the significant impact that oversized breasts can have on a person’s overall health and well-being.

Which Physical Symptoms Contribute to a Patient’s Qualification?

One of the primary reasons breast reduction surgery may be considered medically necessary is the presence of physical symptoms and health concerns caused by very large breasts. These symptoms can vary in severity and may include:

  • Chronic Neck, Shoulder, and Back Pain

The excessive weight of large breasts can strain the muscles and ligaments of the neck, shoulders, and back, leading to chronic pain and discomfort.

  • Poor Posture

Large breasts can alter a person’s posture, causing them to hunch forward to alleviate the strain on their back and shoulders.

  • Skin Irritation and Rashes

The skin beneath the breasts may become irritated and prone to rashes due to friction and moisture buildup, particularly in warm weather or during physical activity.

  • Breathing Difficulties

In some cases, the weight of large breasts can restrict lung expansion and impede breathing, especially when lying down or during exercise.

  • Nerve Compression

The excessive pressure exerted by heavy breasts can compress nerves in the shoulders and chest, leading to numbness, tingling, and even loss of sensation in the arms and hands.

  • Interference with Daily Activities

Activities such as exercise, sports, and even simple tasks like bending over or reaching may be difficult or uncomfortable for individuals with oversized breasts.

Why Are Psychological and Emotional Impacts Considered?

In addition to physical symptoms, oversized breasts can also have a significant psychological and emotional effect on individuals, which may contribute to the medical necessity of breast reduction surgery. Some common psychological concerns associated with large breasts include:

  • Poor Body Image

Many individuals with oversized breasts experience negative body image issues, feeling self-conscious or embarrassed about their appearance.

  • Low Self-Esteem

The physical discomfort and social stigma associated with large breasts can lower self-esteem and self-confidence, affecting various aspects of a person’s life.

  • Social Withdrawal

Those with large breasts may avoid social situations, intimate relationships, or activities that draw attention to their breasts, leading to social isolation and feelings of loneliness.

  • Depression and Anxiety

The chronic physical discomfort and negative body image associated with oversized breasts can contribute to feelings of depression, anxiety, and poor mental health.

What Are the 5 Criteria for a Medically Necessary Reduction?

To determine if breast reduction surgery is medically necessary, healthcare providers typically consider a combination of physical symptoms, psychological concerns, and quality of life factors. Some common criteria for qualifying your breast reduction surgery as medically necessary include:

  1. Breast size: The size and weight of the breasts are evaluated relative to the individual’s body frame and overall health.
  2. Severity of symptoms: The severity and duration of physical symptoms such as pain, discomfort, and skin irritation are assessed.
  3. Impact on daily Life: The extent to which oversized breasts interfere with daily activities, quality of life, and emotional well-being is considered.
  4. Conservative treatments: The effectiveness of conservative treatments such as physical therapy, pain management, and supportive garments in alleviating symptoms is evaluated.
  5. Patient preference: The patient’s personal preferences, goals, and expectations regarding breast reduction surgery are also considered.

Breast reduction surgery can be more than just a cosmetic procedure; it can be a life-changing intervention for individuals suffering from the physical, psychological, and emotional burdens of oversized breasts. For breasts that have also begun to sag due to their weight, pregnancy, or natural aging, reduction surgery typically includes a breast lift.

Where to Go for Help Determining Your Eligibility

By addressing the medical necessity of breast reduction surgery and considering the impact of physical symptoms and psychological concerns on a person’s overall health and well-being, healthcare providers can help individuals make informed decisions about their breast health and get relief from the burdens associated with large, heavy breasts.

Schedule a consultation with a reputable, board-certified plastic surgeon to explore your options and discuss your needs if you believe you may qualify for a medically necessary breast reduction.

If you have seen a specialist about your concerns or have a clear record of complaints with your primary physician, share this information with your plastic surgeon. You may need to provide a release of information that allows these professionals to consult with each other to confirm whether or not you qualify.

Breast Reduction in Long Island, New York

Dr. Pincus is a well-respected, board-certified plastic surgeon who, along with Dr. Daniel Kirk, offers breast reduction surgery with the highest level of care. If you want to learn more about your breast reduction options in Long Island, call  (631) 352-3556 to reach our Smithtown, NY, plastic surgery practice and schedule your consultation today!

Pincus Plastic Surgery

The team at Pincus Plastic Surgery would love to hear from you. If you have a question about a procedure or would like to schedule a consultation, please do not hesitate to contact us today.

New York Office

50 Route 111, Suite 300
Smithtown, NY 11787

Phone (631) 352-3556

Florida Office

875 Meadows Road #3130
Boca Raton, FL 33486

Phone (561) 362-9700

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