Breast reduction surgery is an increasingly popular form of cosmetic surgery in the United States, Canada, and Western Europe. Breast reduction surgery, known as “reduction mammaplasty” in medical terms, is a complex series of procedures that removes excess breast tissue and reshapes a woman’s breasts to bring them into proportion with the rest of her body.
Reduction mammaplasty is done for a variety of reasons, but always only at the request of the female patient. Women choose reduction for a variety of reasons: the weight of the breasts, difficulty finding bras that fit, poor self-esteem concerning body image, pain associated with such heavy breasts, or occupational concerns. While each woman’s reasons for choosing this surgery are different and unique, they all have one factor in common: the need for medical justification for the surgery in order to qualify for medical insurance coverage for the procedure.
Health insurance companies have cracked down over the past decade on cosmetic procedures. Breast augmentation, for instance, in usually not covered by medical insurance-having breast implants inserted to increase the size of the breasts for cosmetic reasons is viewed by most health insurance companies as a personal choice, not a medical necessity. The implants are covered, however, for some reconstruction surgeries after severe accidents or illnesses in which breast tissue was removed, such as cancer-related surgeries. But the average woman walking into a plastic surgeon’s office who wants to have larger breasts for her self-esteem will not have the surgery covered by medical insurance.
On the other hand, when a woman goes to a plastic surgeon for an initial consultation to ask about a reduction, the doctor must determine whether the woman is a candidate for the reduction, and whether medical insurance will cover the procedure. In general, five criteria must be met:
1. The woman’s breasts must be out of proportion to her body shape and height.
2. The woman must experience physical pain-normally back and neck pain-because of the overly large breasts.
3. The woman must have grooves in her shoulders from the weight of the bra pulling down on her shoulders, a result of too-heavy breasts.
4. The woman must experience some level of mental or psychological pain from the breasts.
5. Skin rashes under the breasts or on breast tissue must be present.
This isn’t a definitive list, but it is a series of questions that doctors look at when determining how to approach health insurance companies and having patients qualify for covered breast reductions. If a woman experiences most or all of these issues, the surgeon proceeds to the next step.
In general, the surgeon will do an examination and notice where the excess tissue is located. He or she will explain what size the woman should be after the surgery, and will explain how many grams of tissue will be removed. Specific surgical techniques are discussed in this meeting; for women who wish to be able to breastfeed after the surgery, certain techniques are modified to give the woman the best chance of having the milk glands and canals function well enough to breastfeed in part or in full after surgery. If this is not an issue, then the surgeon will use different tissue removal and reshaping techniques.
Virtually all reduction surgeries also include a breast lift; many women are pleasantly surprised after the procedure to find that the surgeon has defied gravity and given them perky, young-looking breasts. The joy of going from a 48F, for instance, to a 36C and entering a lingerie store to buy a bra off the rack, rather than special ordering from a warehouse that sells bras that look like trusses, is part of the psychological joy some patients experience after breast reduction.
Once the initial consultation with the breast reduction surgeon is complete, the physician will submit pre-surgery forms to the insurance company. The doctor’s office will then call the potential patient to let her know whether the HMO, PPO, etc. will allow full coverage of the surgery. If so, the surgeon then asks the patient to come in for a second appointment. Sometimes, if the patient is carrying extra weight, the surgeon will ask her to lose fifteen or twenty pounds, to see if she goes down a cup size. If so, the surgeon’s approach to the operation will change. A woman who loses breast tissue when she loses weight needs a different surgical approach vs. a woman who does not lose breast tissue when she loses weight.
After the second appointment, the surgeon has a third, and final, pre-surgery appointment with the patient, where strategy is determined. Often, the doctor will draw on the patient’s bare skin to show-literally map out-the incision and reshaping strategy.
Once the patient reaches this point, the next step is surgery. Many patients balk at this point, and back out of the breast reduction surgery itself. Many patients proceed, however; breast reduction surgery patients have the highest satisfaction rate of all cosmetic procedure patients, across the board.
If a woman is considering breast reduction surgery, she needs to do her research, find the right doctor, get pre-approval from her insurance company, and be psychologically prepared for these steps, and be armed with the knowledge that this surgery is complex but ultimately worthwhile in the eyes of most breast reduction patients.
