Breast reduction is an interesting interface between cosmetic and reconstructive breast surgery. It is still frequently covered by insurance companies, but the conditions under which it may be covered vary greatly between insurance carriers. Many require that a certain amount of tissue be removed. Sometimes they want so much removed that the operation is a bad idea. You can't remove so much that the blood supply is too thin or the wounds won't heal. As a response to this overregulation, many plastic surgeons have curtailed their breast reduction practices accordingly. Dr Di Saia still works with PPO insurers with Out Of Network coverage however.
Breast reduction is fundamentally different than breast lift (Mastopexy) surgery because in breast reduction, breast tissue is deliberately removed. Insurance companies cover the surgery not to make the patient look better, but to decrease the weight of the gland in an attempt to decrease back pain, shoulder pain and at times fungal overgrowth under the glands. Quite frankly, your insurance company really doesn't care how you look. This doctor does, but they don't. With this being said, insurance will almost never cover the cost of a revision. You really get one chance to make this work. Dr Di Saia is selective in offering breast reduction and to date has had a very low revision rate.
With this being said, in the right patient this operation is greatly appreciated. One of the doctor's patients from last year commented at follow-up:
"I was happy I had done it, the day after I had done it."
She had paid cash to have hers done not wanting it performed by her HMO's surgeon. For patients in whom back pain is related to breast size and position, the operation is very effective.
Examples
Case #1
Case #2 - Larger
Risks
The outcome of this operation is very subject to the effects of wound healing. Smokers do not tend to do well. Wound healing and scarring in cigarette smokers, diabetics and those on steroids can be unpredictable. Skin loss is more common in these patients in addition to the risk of nipple or areolar loss. Bleeding, infection and sensory loss are infrequent (in low risk patients), but can occur. These tend to be the patient upon whom revisions are contemplated; that is, if they are offered surgery in the first place.
The Process
Those interested in health insurance covering their breast reduction surgery with Dr Di Saia are seen for consultation in the office. If the case seems reasonable, a letter of medical necessity will be sent to the insurance company. If this is approved, we proceed towards surgery. Appeals for denials of that letter are infrequent, but do occur. Dr Di Saia is not an insurance provider for many plans, but patients with Out of Network coverage are still frequently approved.
BREAST MAIN | SITE MAIN
©John Di Saia, MD... an Orange County
California Plastic Surgeon
Serving Southern California since 1997 * (949) 369-5932
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Please note that this resource is offered freely to individuals considering cosmetic breast surgery. No rights are granted and it is not to be reprinted or copied without the author's prior written consent. Understand that some of the information presented may be a matter of professional opinion. Although efforts have been made to assure accuracy, no guarantees are expressed or implied.
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