Does Insurance Cover Breast Reduction Surgery in Texas?
Blog

Does Insurance Cover Breast Reduction Surgery in Texas?

Breast reduction surgery is an excellent solution for women seeking to address disproportionately large breasts. Whether to treat back or neck pain, correct skin irritation or enhance your physique, reduction mammoplasty has helped countless women achieve a slimmer and more comfortable breast contour that is more proportional to their figure and supports the health of the rest of their body. At Austin Plastic & Reconstructive Surgery, one of the most common queries raised by breast reduction patients is:

Will my health insurance cover the cost?

The answer is often yes. However, this will depend on the extent of coverage offered by your health insurance provider. Most providers will have a number of requirements that patients must meet in order to demonstrate that the procedure is medically necessary for your health. Since this process could take several months, it is crucial to consult with your physician and healthcare provider as soon as symptoms occur. At Austin Plastic & Reconstructive Surgery, both cosmetic and medical breast reduction surgery is performed by experienced surgeon Dr. Silvia Kurtovic. In your consultation, the two of you will discuss your medical history, physical symptoms and aesthetic goals to help determine whether you are a suitable candidate for a possible medical breast reduction covered by insurance.

Clinical Problems

Breast hypertrophy is a medical condition that occurs due to the excessive development of glandular tissue. This issue can arise during puberty, secondary to weight gain or as a result of the aging process, where fat deposits naturally shift. Hyperplasia or macromastia refers to the excessive growth of mammary tissue, which often occurs as a result of pregnancy and hormonal changes. These conditions can lead to significantly asymmetrical, overly large or disproportionate breasts that encourage many women to consider reduction mammoplasty. At Austin Plastic & Reconstructive Surgery, we see women of all breast shapes, sizes and concerns seeking medical help for their symptoms. Our compassionate surgeons encourage anyone experiencing these problems to schedule a consultation and learn more about their suitability to undergo breast reduction surgery.

Symptoms That May Qualify You for a Medical Breast Reduction

To qualify for insurance coverage, patients must have persistent symptoms documented by a physician and/or other medical professional. Though symptoms can vary for each individual, the most common problems experienced due to disproportionately large breasts can include:

  • Pain in the back, shoulders or neck
  • Shoulder “grooving” from bras
  • Skin irritation, rashes, infection or ulceration
  • Kyphosis (curved spine)
  • Headaches

Before considering breast reduction surgery, your primary care physician, OB/GYN, orthopedist or other medical provider may prescribe alternate, non-surgical methods for improving your condition, depending on the symptoms you are experiencing. For instance, women suffering back, shoulder or neck pain may benefit from physical therapy or chiropractic treatment. Patients suffering from skin irritation or rashes will likely need to consult a dermatologist before they can qualify for a medical breast reduction.

In any case, to be eligible for possible surgical intervention, you will need to provide documented proof that you have sought alternative methods for a minimum of six months to address the pain, discomfort or irritation caused by excess weight in the breasts, as well as have had a clear mammogram within a year of your projected surgery date. Because of this, it is vital to discuss your symptoms with a medical provider as soon as you experience them, and then pursue non-surgical treatment to build your medical history and, if needed, get a mammogram. Once you are ready to seek surgery, Dr. Kurtovic will discuss your primary concerns and help determine whether you are more suited to a cosmetic or insurance breast reduction.

Cosmetic vs Insurance Breast Reduction

Breast reduction surgery is often considered a multi-purpose treatment. In a reconstructive sense, the procedure aims to remove excess tissue to resolve pain or irritation and restore comfort to your body, making it easier to perform daily tasks and engage in exercise. However, many patients also expect aesthetically pleasing results that complement their body, in which case the procedure may be considered cosmetic. In addition to your documented symptoms, your aesthetic goals will also determine whether you qualify for insurance coverage. Insurance providers require a minimum amount of tissue removed from each breast based on your total body surface area in order for you to qualify for insurance coverage, which may not result in the aesthetic results you are after. In this case, a cosmetic breast reduction would be more suitable.

If you are seeking to have the costs covered, insurance carriers will thoroughly investigate your situation to ensure the procedure is medically necessary. As described above, this takes more than six months of preparation and will include consultations with other healthcare providers and alternative treatment methods. Before approving you for surgery, insurance companies will require letters on letterhead from the medical professionals you have sought non-surgical treatment with regarding your condition and your efforts to resolve symptoms.

Schedule Your Consultation with Dr. Silvia Kurtovic

Inspired by her mother’s breast cancer journey, Dr. Kurtovic is passionate about achieving emotionally and physically fulfilling results for her surgical breast patients. She performs both breast reconstruction and breast reduction surgeries for patients in Austin, Texas and beyond to help them feel more comfortable and confident about their bodies.

Whether you qualify for a medical or cosmetic breast reduction, Dr. Kurtovic draws on advanced surgical techniques to free you of pain and discomfort associated with enlarged breasts, while also optimizing the aesthetic outcome. With a strong commitment to patient care, she can provide you with the results to live a happier, more carefree lifestyle. To learn more about the procedure and your suitability to treatment, schedule a consultation with Dr. Kurtovic by calling our clinic in Austin, TX at (512) 815-0123.

Christine Fisher MD

Leave a Reply

Your email address will not be published. Required fields are marked *

Before
After
Before and After Photo
This image contains nudity. Click to reveal. Actual patient. Results may vary.
View Photo Gallery

Contact Us

I am interested in*
How did you hear about us?*
security code