When Does Insurance Cover Breast Reduction?

Breast reduction can have tremendous benefits for patients with overly large breasts. Not only can the surgery enhance your appearance and self-confidence, but it can also ease physical discomfort and increase your ability to enjoy certain activities. If you are considering breast reduction, you may be worried about how you will pay for your surgery. You may receive insurance coverage for breast reduction if you need the treatment for medical reasons. At our San Antonio, TX, practice, Dr. Peter Fisher will conduct a complete evaluation. Measuring your breasts and observing physical symptoms, he can help determine whether you qualify for insurance coverage. Our team can help you file your claim to obtain the most coverage possible.

Woman holding breast and neck highlighted to show pain
Overly large breasts can cause significant pain and discomfort.

What Is Breast Reduction?

During a breast reduction procedure, Dr. Fisher will remove excess skin, breast tissue, and fat using techniques based on your needs. He can also reduce the size of your areolas and reposition your nipples higher on your breasts. After surgery, your breasts could be several sizes smaller, providing significant advantages for your life.

When Insurance Will Typically Cover Breast Reduction

Insurance will often cover your reduction surgery if you experience significant physical side effects because of the size of your breasts. These side effects can include back, neck, and shoulder pain. You might also experience chafing under your breasts, shortness of breath, and difficulty engaging in certain physical activities. In severe cases, large breasts can cause strain to your spine, leading to permanent skeletal deformities.

Often, insurance companies will only cover your surgery if you have a certain amount removed from each breast. If you have a naturally small frame, they may not require as much tissue be removed. Most insurance policies use the Schnur scale to determine whether breast reduction is deemed medically necessary. Dr. Fisher can perform an evaluation where he will compare the amount of breast tissue to be removed against your body surface area. If the amount to be removed falls above a certain percentile on the scale, insurance will usually cover the cost of treatment.

Breast reduction can help relieve your pain and make daily life and activities easier for you.

Additional Requirements for Treatment

You may need to meet several other requirements before you will qualify for insurance coverage. Your weight is one of the biggest considerations. To be eligible for coverage, you usually must be at or near a healthy weight. Typically, your weight should have been stable for at least several months. Other considerations may include:

  • If you have tried alternative therapies for your discomfort without success. These treatments could include support bras, steroid medications, physical therapy, exercise, and changes in posture.
  • You have had a mammogram in the last year that showed no other issues.

If he believes that you may obtain insurance coverage, Dr. Fisher and his staff can begin gathering the details necessary for your claim. You will require letters from your internal doctors confirming your physical symptoms and their opinion that reduction will reduce negative effects. If your first claim is denied, you can file an appeal.

Discover Your Insurance Options

Breast reduction can help relieve your pain and make daily life and activities easier for you. Contact our office to schedule a consultation and find out if your breast reduction surgery qualifies for coverage.

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Dr. Fisher has been available to answer all of my questions and provide me with not only professional medical expertise, but also a much appreciated level of personal empathy. I would 100% recommend Dr. Fisher to anyone who is considering plastic surgery.



San Antonio Office

7950 Floyd Curl Dr
Ste 1009
San Antonio, TX 78229

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