When It is Breast Reduction Covered by Insurance?, Raleigh, NC*

Many women wonder if their breast reduction will be covered by insurance. Patients considering this must be referred by their primary care physician . They must exhibit symptoms associated with neck pain, upper back pain, shoulder pain , shoulder grooves and possibly rashes developing underneath the breast folds. They must also document measures to treat these symptoms such as use of anti-inflammatories, physical therapy or chiropractic manipulation and use of support bras. Efforts at weight loss are also recommended. The plastic surgeon then documents physical signs of macromastia including measurements to determine the distance from the sternal notch to the nipple which generally needs to be 28 cm or greater which demonstrates breast ptosis. Additionally, the amount of breast removal per breast must meet the Schnurr sliding scale criteria. This is the amount of breast tissue required for removal and depends on body surface area; larger patients with larger body surface area require more tissue removed. Some patients will benefit from reduction although the amount of tissue removed would not meet insurance-based criteria. In these cases, patient may pay out-of-pocket but still reap the benefits of breast reduction such as relief of neck and back pain as well as improved breast appearance. Although Dr. Lyle does not participate with insurance plans he still performs many cash pay breast reductions.