In order to get insurance coverage for breast reduction, it is imperative to meet criteria that have been established by insurance companies for medical coverage. The premise for medical coverage is that your breast weight is creating torque on your upper back and neck strain. As such, your insurance company is expecting you to remove significant breast weight so that the weight removed relieves your neck strain.
Criteria established to figure out how much you must remove has been established and includes first calculating your body surface area. The body surface area is then used to cross-reference the weight of excisions required using the Schnur scale.
Calculating Body Surface Area
Calculating body surface area requires your height and weight. The formula for calculating the body surface area is calculated by taking the square root of your height(cm) x weight(kg) / 3600. If this calculation is daunting for you, you can just use the body surface area chart below.
Criteria for Breast Reduction Approval
Criteria for breast reduction approval then is obtained by first cross-referencing a minimum breast weight excision chart called the Schnur scale. Specifically, once you have your Body Surface Area calculated, then you will cross-reference your B.S.A. with the minimum excised weight required from each breast as indicated by the chart below.
|Area (m2)||Grams of breast tissue to be removed|
So for example, let us consider that you are 5’7” and 180 pounds, this will give you a Body Surface Area of 2.0. Then you cross-reference the B.S.A. with the Schnur scale which will show you that you must be willing to let your surgeon remove 628 grams from each breast. Typically, the weights required approximately 30 percent of your breast weight if you are trying to get an estimate.
In addition, you must have attempted anti-inflammatory medications such as Alleve, Motrin, Aspirin for at least six months. Finally, you must have attempted supportive bras for at least one year without any improvement in your symptoms of neck and upper back strain.
How to get insurance coverage for your breast reduction Summarized
In summary, if you are interested in getting insurance coverage for your breast reduction, you must consult a plastic surgeon. He or she will take your history, do an examination, and calculate your body surface area(B.S.A.). Your B.S.A. will then be cross referenced on the Schnur scale to determine how much weight you will require to be removed from each breast.
As long as you are comfortable with this weight of removal, and you have failed improvement in your neck strain with both anti-inflammatory medications and supportive bras, you should be approved for this surgery. Of note, your breast surgeon also has to document shoulder grooving with a photograph of your breast and chest area. If you are considering a breast reduction, we encourage you to make a consultation with Dr. Mowlavi so that he can assist you with this process.
A 29-year-old female patient shows how to get insurance coverage for breast reduction.