Breast Reduction Surgery: A Case Study

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Extremely large breasts can cause a range of health problems that may affect a woman's ability to perform basic daily tasks. Overly large and disproportionate breasts make activities like standing, sitting or even sleeping difficult. Large breasts create constant weight on the shoulders; that weight causes pain and alters posture. The medical term for the condition is macromastia and there are both surgical and nonsurgical ways to treat it.

While some forms of macromastia may respond to nonsurgical treatments, the patient may not see long-term relief. For many patients, breast reduction surgery is the best course.

Does your Insurer Offer Coverage for Breast Reduction Surgery?
If you are considering this procedure, your first step should be to read your …show more content…

In the letter, your surgeon will explain your symptoms and provide information such as an estimated weight of the breast tissue to be removed. They may also take photos of your breasts for the insurer's doctors to examine. Note that if you fail to provide this information, your insurance company may consider the procedure "cosmetic" and deny coverage.

How Does Your Insurance Provider Determine Whether Breast Reduction Surgery is Necessary?
While some insurers use current standards of care for the treatment of macromastia, others may use the 26-year-old Schnur Sliding Scale. Many in the medical community consider this scale to be outdated. The Schnur Sliding Scale requires the patient's body surface area and the weight of their breast tissue to be compared. If the body surface area and breast tissue weight fall below the 22nd percentile, the surgery is labeled as not medically necessary and therefore "cosmetic." If it is considered cosmetic, it will not be covered.

The Schnur Sliding Scale may discriminate against overweight women, who may not receive coverage regardless of their

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