When Breast Reduction Is a Medical Necessity

Let’s be honest — we live in a global society obsessed with female breasts. From the great iconic breasts of Venus de Milo to the immortal words of Bob Seger’s “Night Moves” (” … with big dark eyes and points all her own sitting way up high, way up firm and high”), history proves our fascination.

Thanks to the fixation on breasts, we can dine at Hooters while wearing our “Save the Ta-Tas” T-shirt. But everything about breasts isn’t always fun and games.

The Dark Side of Cleavage

Imagine lying in bed at night and trying to breathe with two bags sitting on your chest, each weighing about 10 pounds. Think about how your neck, back and shoulders would feel if you carried an additional 20 pounds or more centered on your sternum (breast bone).

Imagine carrying this weight every day, 24/7, with no relief. Imagine suffering under this encumbrance day after day, year after year, with no relief.

That’s what it feels like to a woman with excessively large breasts. (Yes, there are some who choose those DDDs, and more power to them!) But for those who find themselves needing a size E cup or larger, these bulky breasts can interfere with their health, well-being, self-esteem and ability to perform normal functions of daily living.

Breasts that have grown too large are a health hazard, and may call for a breast reduction medical necessity.

Is Breast Reduction Covered by Insurance?

Most Houston breast reduction surgery falls under the heading of “cosmetic,” and thus “elective” and not a medically necessary breast reduction by insurance companies. But there are valid medical reasons for breast reduction.

Breast Reduction Requirements for Insurance

Many times, the decision to have a breast reduction or not lies with our insurance carriers. A check of several major insurance providers yields a general list of symptoms and conditions that may constitute a “medical necessity” for breast reduction:

• Female breast hypertrophy (increase in tissue volume)
• Persistent pain in the back, neck and/or shoulders with accompanying muscle spasms
• Chronic skin irritation in the fold below the breast
• Headaches
• Painful kyphosis (forward rounding of the spine)
• Pain, discomfort and/or ulceration caused by bra straps cutting into shoulders
• Paresthesia (abnormal sensation, such as “pins and needles”) in the upper extremities
• Forced to restrict physical activities to the level of functional impairment
• Chronic pain in the breasts

This list is a complication of information from MassHealth’s “Guidelines for Medical Necessity Determination for Breast Reduction,” Aetna’s Policy Number 0017 (Reduction Mammoplasty), and UnitedHealthcare’s Guideline Number CDG.004.10. If you’re considering any type of breast surgery — reduction, augmentation, lift or reconstruction — be sure to check with your insurance provider about the extent of coverage you have.

Ver Personal Medical Reasons for Breast Reduction Surgery

A woman’s breasts are part of how she defines herself. We all want perfect, perky breasts — those points all our own, sitting way up firm and high. But life rarely works out that way. A woman’s body changes with childbirth and the passage of time.

Breast reduction can be cosmetic for some, but for most, it is a necessity for quality of life. Being unable to sleep because of the pressure on our chests and unable to lay on our stomachs because of the mass of breast tissue, pain, numbness in our hands, chronic skin ulceration beneath the breasts — these can break a woman’s spirit over time.

Add in the inability to find clothes that fit properly. That alone can be demoralizing for a woman. Pile on functional restrictions: You’re already carrying the weight of the breasts; add in the weight of a 2-year-old child, and it becomes unbearable to pick up the one thing most precious to a mother’s heart.

If you’re suffering with breasts that are too large, check with your Houston plastic surgeon about reduction surgery. It can be a life-changing transformation.