Skip to Content

Does Covered California cover breast reduction?

Breast reduction is a surgical procedure that involves removing excess breast tissue and skin to reduce the size and weight of the breasts. While many people seek breast reduction for aesthetic reasons, for some individuals, it can also provide relief from physical symptoms such as pain, discomfort, and limited mobility.

If you are a resident of California and are enrolled in the Covered California health insurance marketplace, you may be wondering if breast reduction is a covered benefit under your plan. The good news is that Covered California does cover breast reduction surgery, but with certain limitations and requirements.

According to Covered California, breast reduction surgery is considered a medically necessary procedure if the patient experiences symptoms that significantly impact their quality of life, such as chronic pain, rashes or skin irritation, difficulty finding clothing or bras that fit properly, or difficulty participating in physical activity due to the size and weight of their breasts.

To be eligible for coverage, patients must first meet certain criteria, such as having a documented history of symptoms related to breast size, trying non-surgical treatments (such as physical therapy, medications, or specialized bras) without success, and undergoing a comprehensive medical evaluation by a board-certified plastic surgeon or other healthcare professional who specializes in breast reduction.

Depending on your specific plan, there may also be limitations on the amount of coverage provided for breast reduction, such as caps on the amount that will be paid for hospitalization, anesthesia, and surgical fees. Additionally, some plans may require prior authorization or documentation of medical necessity before approving coverage for breast reduction surgery.

It is important to note that not all plans offered through Covered California cover breast reduction surgery, and the level of coverage provided may vary depending on the specifics of your plan. To find out whether your plan covers breast reduction surgery, you can review your plan documents or contact your insurance provider directly.

It is also recommended that you consult with a qualified plastic surgeon or other healthcare professional to discuss the risks, benefits, and expected outcomes of breast reduction surgery before making a decision.

What size breasts qualify for reduction?

Breast reduction surgery is a procedure that is usually performed for women who want to alleviate the physical and emotional discomfort that comes with extremely large breasts. However, there is no specific size limit for breast reduction surgery. Generally, the size of the breasts does not determine whether a person is eligible for breast reduction surgery.

Instead, the surgeon will evaluate the patient’s individual condition, such as factors like breast size, body mass index (BMI), breast shape, nipple position, and sagging.

Typically, women with large breasts that are causing chronic physical pain or discomfort, such as neck, shoulder, or back pain, may be a good candidate for breast reduction surgery. Women who are experiencing migraines, rashes, or difficulty breathing due to the weight of their breasts should also consider this procedure.

Additionally, women with large breasts that affect their posture or lead to poor self-esteem, depression or anxiety may be suitable for breast reduction surgery.

The size of the breasts alone does not determine the qualification for the surgery, as it is the pain, discomfort and self-esteem issues that result in candidacy for the surgery. Therefore, it is important to consult with a qualified plastic surgeon who will assess your unique needs and help you determine if breast reduction surgery is right for you.

breast reduction surgery is a highly effective procedure that can significantly improve a patient’s quality of life, comfort and self-confidence.

Will insurance cover breast reduction if you are overweight?

Breast reduction surgery, also known as reduction mammoplasty, is a surgical procedure that aims to reduce the size of the breasts by removing excess breast tissue, fat, and skin. This type of surgery is typically performed on women who have large, heavy breasts that cause discomfort, pain, and other health problems, such as back, neck, and shoulder pain, skin irritation, and breathing difficulties.

One common question that many women ask before considering breast reduction surgery is whether their insurance will cover the procedure if they are overweight. The answer to this question is not straightforward and depends on several factors, including the insurance plan, the individual’s medical conditions, and the severity of their symptoms.

In general, most health insurance plans will cover breast reduction surgery if it is deemed medically necessary. However, whether or not someone who is overweight would receive coverage for the procedure depends on the specific insurance plan and the individual case in question. Insurance providers will consider several factors, such as the extent of the breast reduction that is required, the individual’s overall health, and the severity of their symptoms.

If an individual is overweight and seeking breast reduction surgery, they may be required to meet certain criteria to be deemed eligible for coverage. For example, some insurance providers may require proof that the individual has tried other methods to alleviate their symptoms, such as physical therapy or weight loss programs.

In addition, some insurance providers may require that the individual has a body mass index (BMI) below a certain level before approving the surgery.

It is recommended that individuals who are considering breast reduction surgery consult with their insurance provider to determine their coverage options. In addition, it is important to consult with a qualified plastic surgeon who can assess the individual’s medical condition and advise them on the best course of action.

the decision to undergo breast reduction surgery should be based on the individual’s health, well-being, and quality of life, rather than their weight.

How to get a breast reduction covered by insurance?

Breast reduction surgery is a specialized cosmetic surgery that is performed to reduce the size of breasts. It is generally done to alleviate physical and emotional pain that comes with heavy and pendulous breasts that can often cause back pain, neck pain, and other similar health problems. In some cases, breast reduction surgery is not treated as cosmetic but rather an essential medical need.

When a reduction surgery is required for medical reasons, it becomes crucial to know how to get the procedure covered by insurance.

First, you need to check the policy of your insurance provider regarding coverage for breast reduction surgeries. Different insurance providers have varying policies on this procedure, and it’s important to understand the specific requirements that need to be met before your insurance can cover your procedure cost.

You should request a copy of your insurance policy or contact your insurance provider to clarify its conditions.

Typically, insurance providers require that you present documented evidence of medical necessity for the breast reduction surgery. Therefore, you would need to illustrate to your doctor in detail the physical discomfort and health problems resulting from the size of your breasts. This information will be documented in your medical chart, and your doctor may need to provide a letter of recommendation stating that a breast reduction surgery is necessary for your physical health.

Next, you must choose a Board Certified Surgery, who will be experienced in handling your case and can prove your condition is medically necessary. Proper documentation procedures are essential. You can request to see before and after images from their previous procedures that are similar in nature to yours.

If you have doubts, you can always seek a second opinion, but it is crucial to have a surgeon who has the necessary experience in handling the procedure.

The procedure for breast reduction surgery coverage by insurance begins by checking the insurance policy on this procedure, citing reasons why it is medically necessary, working with your doctor, providing proper documentation, and choosing a qualified Board Certified surgeon. These processes will increase your chances of getting the surgery covered by your insurance company.

How much weight should I lose before breast reduction?

The decision to undergo breast reduction surgery is a personal one and should be based on a variety of factors, including your physical health, medical history, body shape and proportions, and your overall aesthetic goals. When it comes to determining the ideal amount of weight to lose before breast reduction surgery, there are several factors to consider.

Firstly, it’s important to understand that breast reduction surgery is typically designed to remove excess breast tissue and skin in order to reduce the size and weight of the breasts. The extent of the reduction may depend on factors such as your pre-operative breast size and the shape and position of your breasts.

In some cases, weight loss may be recommended prior to surgery in order to achieve the best possible results. This is because excess weight can put additional strain on the breast tissue, which can lead to discomfort and limit the effectiveness of the procedure.

In general, it is recommended that individuals undergoing breast reduction surgery be at a stable weight that is within their ideal BMI range. If you are significantly overweight, then working to lose some weight prior to surgery can help ensure that the results are more successful and long-lasting.

That being said, the exact amount of weight you may need to lose before breast reduction surgery is highly individualized and will depend on a variety of factors, including your overall health, age, body composition, and more. Your plastic surgeon will be able to provide you with personalized guidance on this matter during your consultation.

One thing to keep in mind is that breast reduction surgery is not a weight loss procedure. While reducing the size and weight of the breasts can certainly make it easier to exercise and maintain a healthy body weight, it should not be pursued as a primary means of weight loss.

The decision to undergo breast reduction surgery should be based on a variety of factors, including your own personal preferences, goals, and overall health. By working closely with an experienced plastic surgeon, you can ensure that you achieve the best possible results from your breast reduction surgery.

How many cup sizes reduce breast reduction?

Breast reduction surgery is a medical procedure that aims to decrease the size and volume of the breasts. The amount of breast tissue removed during breast reduction surgery depends on the patient’s individual needs and desires. The reduction in cup sizes, therefore, is a highly individualized aspect of the surgery and can vary significantly from one patient to another, depending on the amount of breast tissue removed and the starting size of the breasts before surgery.

Generally, breast reduction surgery can reduce the breast size by one to several cup sizes. Cup sizes are determined by the difference between the circumference of the bust and the ribcage, measured in inches. The difference between these two measurements is the cup size. For example, if the circumference of the bust is 38 inches, and the circumference of the ribcage is 34 inches, the cup size would be a D cup.

However, after breast reduction surgery, this cup size could decrease to a C, B, or even an A cup, depending on how much breast tissue is removed.

The amount of tissue removed during breast reduction surgery can vary depending on several factors, such as the patient’s preoperative breast size, the amount of sagging or drooping of the breast, the patient’s body type, and desired outcome. Some women may only require a small reduction of breast tissue, resulting in a one or two-cup size reduction, while others may require a more significant reduction, which could reduce the breast size by three or more cup sizes.

During the consultation process, the plastic surgeon will discuss the patient’s desired outcome, evaluate their unique anatomy carefully, discuss the available options for breast reduction surgery, and create personalized treatment recommendations. In this way, the patient and surgeon can agree on the desired breast size and shape, taking into account the potential reduction in cup size that can be realistically achieved with the surgery.

The reduction in cup sizes resulting from breast reduction surgery varies depending on the individual needs of the patient. Breast reduction surgery can reduce breast size by one to several cup sizes, with the exact reduction varying depending on factors such as the starting size and shape of the breast, the amount of tissue removed, and the desired outcome.

It is crucial to discuss these factors with an experienced plastic surgeon to achieve the desired results successfully.

Does weight matter for a breast reduction?

Yes, weight can play a significant role when it comes to the suitability and effectiveness of a breast reduction procedure. The main objective of this surgical procedure is to reduce the size and weight of a person’s breasts, which can cause discomfort, pain, and other physical problems. Therefore, it makes sense that the overall weight of a person will make a difference in their suitability for the procedure.

There are a few reasons why weight should be considered when determining if a person is a good candidate for a breast reduction. First, heavier people may be at a higher risk for complications during and after the surgery. This is because they may have more fatty tissue in their breasts, which can make the procedure more difficult and increase the likelihood of bleeding, infection, and other issues.

Second, the amount of breast tissue and skin to be removed during the surgery may be limited by a person’s weight. For instance, a person with a lot of excess body fat may not be able to have as much breast tissue removed during the surgery, as it may not be safe or practical to do so. This can limit the amount of reduction that can be achieved and may lead to dissatisfaction with the results.

Finally, weight can also impact the overall appearance and shape of a person’s breasts after a reduction. For instance, if a person loses a significant amount of weight after the surgery, their breasts may become droopy again, which can be frustrating and require further correction.

While weight is just one of many factors to consider when determining if a person is a good candidate for a breast reduction, it does matter. A qualified plastic surgeon can assess a person’s overall health, medical history, and breast size and shape to determine if a breast reduction is appropriate for them, regardless of their weight.

However, for the best results, it is recommended that a person achieve a healthy weight and maintain it after the surgery to ensure the longevity of the results.

What are considered excessively large breasts?

The perception of what constitutes excessively large breasts can vary greatly from person to person, and can be influenced by cultural and societal norms. From a medical standpoint, breasts that are too large for a person’s body size can cause physical discomfort and health problems, such as back pain, neck pain, shoulder pain, skin irritation or infections, and difficulty breathing.

In general, breasts that are larger than a woman’s natural proportion or cause physical health problems can be considered excessively large. However, it is important to note that breast size is a personal matter and should be based on what the individual feels comfortable with, rather than an external standard or expectation.

the decision to pursue breast reduction surgery or other treatments to address excessively large breasts should be made in consultation with a qualified healthcare provider.

How long do you have to be off work after a breast reduction?

The recovery period following a breast reduction surgery can vary depending on the individual and the extent of the procedure performed. It is important to follow the guidance of your surgeon and allow yourself ample time for proper healing before returning to work.

Generally, it is recommended that patients take a minimum of one to two weeks off from work following the surgery. During this time, it is important to rest and avoid any strenuous activities or heavy lifting.

After the first week or two, patients may feel comfortable returning to work as long as their job requirements do not involve any physical strain or heavy lifting. Some patients may need to continue taking time off work for up to four to six weeks depending on the extent of the surgery and their individual healing process.

It is important to allow your body to fully heal before returning to work or engaging in any physical activities to avoid complications or setbacks in your recovery. Your surgeon will provide you with specific guidance regarding your recovery timeline and when it is safe for you to return to work.

What do size F breasts weigh?

It is difficult to give a precise answer to this question as the weight of breasts can vary greatly depending on a number of factors, such as the individual’s body type, the amount of breast tissue, and the size and density of the breasts. However, on average, a cup size F breast can weigh anywhere between 1.5 to 3 pounds each.

This means that a woman with F cup size breasts may be carrying an extra 3 to 6 pounds of weight on her chest.

It is also important to note that breast size and weight can change throughout a woman’s life, especially during hormonal changes such as pregnancy and menopause. Additionally, factors such as breast implants or weight gain can also affect breast size and weight.

It is worth mentioning that the weight of the breasts can pose physical and emotional challenges for some women. The added weight can cause back and neck pain, posture issues, and difficulty finding comfortable clothing and undergarments. It can also impact self-esteem and body confidence. Therefore, it is important for women with larger breasts to be aware of the potential challenges and seek support and resources to alleviate any discomfort.

How much does breast reduction cost near California?

The cost of breast reduction surgery in California can vary greatly depending on several factors such as the surgeon’s experience and expertise, the geographic location, the clinic or hospital where the procedure is performed, the extent of the surgery, and other associated costs. According to recent estimates, the average cost of breast reduction surgery in California ranges from $7,500 to $12,500, including surgeon’s fees, anesthesia, facility charges, and other pre- and post-operative care expenses.

However, it is advisable to note that the cost of breast reduction surgery is not a one-size-fits-all estimate, and it may vary widely depending on the individual patient’s needs and circumstances. Insurance may also factor into the cost of breast reduction surgery. Some insurance companies may cover the cost of breast reduction surgery if it is deemed medically necessary or if the patient suffers from chronic pain or physical symptoms due to the size of their breasts.

It is always recommended that patients consult with a board-certified plastic surgeon to learn more about their individual cost of breast reduction surgery. The surgeon can provide the patient with a detailed estimate of costs based on their specific goals for the procedure, medical history, and other individual factors.

Patients who are interested in undergoing breast reduction surgery in California should also take the time to research and select a highly qualified and experienced surgeon to ensure the best possible outcome. Many reputable plastic surgery clinics in California offer financing options to help patients manage the cost of the procedure over time, and it is always worth discussing these options with the surgeon during the consultation period.

the cost of breast reduction surgery should be weighed against the many benefits it offers, including improved quality of life, increased confidence, and potential relief from chronic pain and physical symptoms.

How big do your breasts need to be to get a reduction?

Breast reduction surgery is an option for women with overly large breasts, which can cause discomfort, pain, and a host of other physical problems. Typically, women who seek breast reduction surgery have breasts that are disproportionately large relative to their body frame. There really isn’t a fixed size or measurement that determines whether or not a woman is a candidate for breast reduction surgery.

the decision to undergo breast reduction surgery or not is up to the woman and her doctor.

A breast reduction surgery, also known as reduction mammoplasty, is a surgical procedure where excess breast tissue, skin, and fat are removed from the breasts. This surgery can help reduce the weight of the breasts, which can alleviate a variety of discomforts. The ideal breast size for a woman is individual and subjective, and it can vary widely depending on her height, weight, body frame, and preferences.

Women with large breasts, typically with cup sizes larger than DD or larger, may be good candidates for a breast reduction surgery. However, breast size alone is not the only factor to consider when deciding if a reduction is necessary. Physical factors such as neck pain, back pain, shoulder pain, skin irritation, and posture issues, as well as psychological factors such as self-esteem and confidence, are also taken into consideration.

In addition to medical reasons, some women may elect to have a breast reduction surgery for cosmetic reasons. For instance, they may prefer a more proportional breast size or want to improve their body image. Some women may even have breast asymmetry, where one breast is significantly larger than the other.

The bottom line is that the decision to have a breast reduction surgery should be based on a combination of factors, such as health concerns, physical symptoms, and personal preferences. A woman considering breast reduction surgery should consult with a qualified plastic surgeon to determine whether or not it is the right choice for her.

What makes a breast reduction medically necessary?

Breast reduction is a surgical procedure that aims to reduce the size of the breasts by removing excess tissue and skin. This is often done for cosmetic reasons, but there are also a variety of medical reasons that may make breast reduction necessary.

One of the most common medical reasons for breast reduction is chronic pain and discomfort in the neck, shoulders, and back. Large breasts can put a great deal of strain on these areas, causing chronic pain and even nerve damage.

In addition, large breasts can also cause skin irritation and rashes, particularly in the area under the breasts where skin can rub against itself or against clothing. This can lead to chronic infections, chafing, and discomfort.

Breast reduction may also be necessary for individuals with asymmetrical breasts, where one breast is significantly larger than the other. This can cause discomfort and self-consciousness, making breast reduction an important option for those seeking balance and proportionality in their breasts.

Finally, some individuals may choose breast reduction as part of their treatment for gender dysphoria, where the size of the breasts may be a significant source of distress and discomfort. In these cases, breast reduction can be an important step towards feeling comfortable and confident in one’s own body.

Breast reduction can be medically necessary for individuals experiencing chronic pain and discomfort, skin irritation, asymmetry, or for those seeking gender affirmation. It is important to discuss these concerns with a medical professional to determine if breast reduction is the right choice for you.

Is it painful to have a breast reduction?

Breast reduction surgery, also known as reduction mammoplasty, is a surgical procedure that involves the removal of excess breast tissue, fat, and skin to achieve a breast size that is more proportionate to the rest of the body. The main aim of this procedure is to reduce the size and weight of the breasts, which can cause pain, discomfort, and physical limitations such as back, shoulder and neck pain, skin irritation, and postural problems.

During the breast reduction surgery, the surgeon makes incisions around the areola, along the crease under the breasts, and in a vertical line between the areola and the crease. The excess tissue, fat, and skin are then removed from the breasts, and the remaining tissue is reshaped to create a smaller and firmer breast.

While breast reduction surgery is a major surgical procedure, it is generally well-tolerated by most patients. Most of the discomfort or pain experienced during the procedure is usually managed through the administration of anesthesia or mild sedation to keep the patient comfortable throughout the surgery.

After the surgery, some discomfort, pain, and swelling are expected, and patients may be advised to take pain relievers, wear a surgical bra or compression garment, and avoid strenuous activities for some time. It is also crucial for patients to follow their surgeon’s post-operative instructions closely, including regular dressing changes, drains, and limitations on physical activity.

Breast reduction surgery can be mildly painful, and patients may experience some discomfort during the recovery period. However, these symptoms can be effectively managed with adequate pain relief, rest, and proper aftercare, allowing the patient to achieve a smaller, more comfortable breast size and improved physical and emotional well-being.

What are the symptoms of needing a breast reduction?

Breast reduction surgery, also known as reduction mammoplasty, is a procedure aimed at decreasing the size and weight of the breast by removing excess tissue and skin. There are a number of symptoms that may indicate a need for breast reduction surgery.

One of the most common symptoms is chronic pain in the neck, back, and shoulders. Large breasts place a significant amount of weight on the chest, which can cause discomfort and strain in these areas. This can lead to ongoing back pain, neck pain, and shoulder pain that can interfere with daily activities and overall quality of life.

Another symptom of needing a breast reduction is difficulty exercising or participating in physical activities. Large breasts can make it challenging to engage in physical activities that require a lot of movement or bouncing, such as running or jumping. This can make it difficult to maintain physical fitness and can contribute to weight gain or other health issues.

Skin irritation and infection is also a symptom that can indicate a need for breast reduction surgery. The skin underneath the breasts may become irritated and infected due to constant sweating and friction, leading to rashes, sores, and unpleasant odors. The excess skin and tissue of the breasts can also make it difficult to find properly fitting bras, which can lead to chafing and other forms of skin irritation.

In addition to these physical symptoms, women may also experience emotional and psychological distress due to their large breasts. They may feel self-conscious, embarrassed, or uncomfortable in social situations, which can impact their overall wellbeing and mental health.

If you are experiencing any of these symptoms and believe that your breast size is impacting your physical and emotional wellbeing, it may be time to consider breast reduction surgery. A qualified plastic surgeon can assess your individual situation and provide guidance on whether this procedure is appropriate for you.

Resources

  1. Health Services You Can Get for Free – All You Need Is a Plan
  2. Summary of Benefits and Coverage – Covered California
  3. Women’s Health: Access and Benefits for Women in California
  4. Will Blue Shield of California cover my breast reduction? What …
  5. Breast Reduction | Cosmetic Services – Northern California