Dr. Saber’s Blog

Will Insurance Cover a Breast Reduction Surgery? Everything You Need to Know

What is a reduction mammaplasty?

Reduction mammaplasty is the medical term for breast reduction surgery. Patients sometimes request reduction mammaplasty for cosmetic reasons, but it is also recommended as a treatment for macromastia (large breasts). For this surgical procedure, I remove excess fat, breast tissue, and skin.

Most women who undergo breast reduction surgery are very satisfied with their results. Men with gynecomastia (abnormally enlarged breasts) may also choose to have “male” breast reduction.

A breast reduction can be performed at any age but it’s best to delay surgery until the breasts are fully developed. Otherwise, a second surgery may be required later in life.

Breast Reduction Insurance Coverage

Why do women choose to have breast reduction surgery?

Reduction mammaplasty is indicated for the treatment of symptomatic macromastia. Commonly reported symptoms may include:

  • upper back pain
  • neck pain
  • shoulder pain
  • poor posture
  • breast pain, abscesses, and infection
  • skin indentations from overworked bra straps
  • irritation and dermatitis (skin rash) in the breast folds due to constant skin friction
  • Psychological effects like poor self-image, restricted physical activity, and difficulty finding or fitting into bras or clothing.

Pain in the neck, shoulder, and back is caused by the stress placed on the musculoskeletal system due to large breasts.

Since these symptoms significantly affect the quality of life and the ability to function, many patients believe a reduction procedure is medically necessary and included in health insurance coverage This is not the case.

Patients sometimes request reduction mammaplasty for cosmetic reasons, but it is also recommended as a treatment for macromastia…

Is breast reduction considered cosmetic surgery?

Cosmetic plastic surgery enhances or reshapes parts of the body to improve the patient’s appearance or confidence. Reconstructive surgery treats parts of the body affected aesthetically or functionally by infection, tumors, disease, developmental abnormalities, or trauma.

Reconstructive plastic surgery may be covered under insurance, but cosmetic plastic surgery is elective and not covered.

For insurance purposes a breast reduction is considered a cosmetic procedure unless the patient can prove:

  • suffering from several health issues caused by macromastia, and
  • attempted remediation in the form of medical intervention to resolve the issues.

Insurance companies generally request 6-12 months of documentation and treatment by either a physical therapist, chiropractor, dermatologist, or orthopedist before turning to surgery. The threshold of medical necessity must be met before an insurance carrier considers breast reduction a reconstructive procedure and medically essential for the patient.

When there is limited or no functional impairment associated with the condition, any treatment would generally be considered to be for cosmetic reasons.

Does insurance cover a breast reduction?

How to get a breast reduction covered by insurance is found in your personal insurance policy — checking for coverage exclusions is essential. If breast reduction surgery/reduction mammoplasty is not considered an exclusion, the policy will outline the necessary criteria for coverage. This should include:

  • your insurance company’s definition of medical necessity for breast reduction coverage
  • detailed patient qualifications for procedure approval
  • any additional criteria for obtaining coverage

While requirements vary by insurance plan, many request the following:  

1. Photographic documentation of “breast hypertrophy” — or overgrowth — taken at the time of consultation.
2. Medical records demonstrating persistent symptoms (for at least one year) — in multiple areas of the body — directly caused by heavy breasts.
3. Documentation of pain that does not improve after months of nonsurgical, conservative treatments, such as:

  • NSAIDs
  • muscle relaxers
  • physical therapy
  • dermatologic care
  • orthopedic or chiropractic evaluation
  • medically supervised weight loss
  • support bras with wide straps

4. An estimation of the amount of breast tissue the surgeon will remove from each breast, based on the patient’s body surface area using a chart called the Schnur Sliding Scale.
5. A statement from the plastic surgeon testifying that the patient’s symptoms are due to breast size and that a breast reduction will improve the condition. 

Unfortunately, the rate of preauthorization denial remains high and has been steadily increasing. Insurance criteria can be arbitrary. Proper documentation and participation in the appeal process by a plastic surgeon may improve the rates of insurance approval.

Breast Reduction Insurance Coverage

Breast reduction is also authorized to balance a healthy breast when the other was affected by breast cancer and its treatment. This treatment is protected by the Women’s Health and Cancer Rights Act of 1998 and ensures breast reconstruction of the affected breast and the balancing procedure to match the healthy breast are covered.

How much does breast reduction surgery cost?

According to the American Society of Plastic Surgeons, the average cost of a reduction mammaplasty is approximately $5,900 as of 2020. The surgeon’s fee differs depending on experience and expertise, surgical techniques used, and practice location. Follow-up visits after about six weeks are usually included in the surgical costs, which are also covered by insurance for breast reduction.

What happens during a reduction mammoplasty procedure with Dr. Saber?

Breast reduction surgery is an outpatient procedure, meaning there is no overnight stay in the hospital. However, since general anesthesia is given during the procedure, transportation is required to return home.

In general, the procedure involves:

  • The incision is made around the areola (the pigmented circular area around the nipple) and then vertically down to the breast crease.
  • In some cases, an incision will also be made under the breast fold (the place where the breast and the chest meet).
  • Excess fat, skin, and breast tissue will be removed to reduce the breasts’ overall size.
  • Then, Dr. Saber will reshape the breasts and reposition the nipples and areolas for a lifted appearance, if desired. The areolas can also be reduced in size for a more natural appearance.
  • If a pre-surgical decision was made to reduce excess fat on the sides of the chest, this is accomplished through liposuction.
  • The incisions are closed with sutures in multiple precise layers to reduce tension and minimize post-operative scarring.

If you’re thinking of getting a breast reduction, schedule a consultation with Dr. Saber, a board-certified plastic surgeon. It’s important to understand what it involves, and the possible risks and complications.

Considering breast reduction surgery near Los Angeles? Schedule a consultation with Dr. Saber

Dr. Sepideh Saber is a board-certified plastic surgeon providing cosmetic procedures and surgeries from a more sensitive, female perspective for patients of all ages, genders, and orientations. She ensures that all questions are answered so that each patient can make a truly well-informed decision.

Keeping her patients safe remains her top priority. She employs the latest state-of-the-art techniques and performs her procedures in the top surgical centers and hospitals, where she has full admitting privileges.

Dr. Saber takes her patients’ safety very seriously. Her facility’s Covid-19 patient safety procedures exceed all CDC and World Health Organization recommendations. Masks are always required in our office during the coronavirus pandemic.

Dr. Saber is located in Encino, CA for patients throughout the Los Angeles area. We are also convenient to Encino, Woodland Hills, Sherman Oaks, Calabasas, Burbank, Glendale, Hidden Hills, Agoura Hills, Northridge, North Hollywood, Malibu, Topanga, Canoga Park, Reseda, Valley Glen, Chatsworth, West Hills, Winnetka, Universal City, Bel Air, Beverly Hills, Downtown Los Angeles, Silverlake, and Echo Park.

To request a consultation, please call (877) 205-4100 or schedule a consultation online.

Dr. Saber graduated from Stanford University’s world-renowned medical school and did her plastic and reconstructive surgery residency at the equally lauded University of Southern California. She then completed a fellowship at New York University in the extremely challenging and delicate disciplines of hand surgery and microsurgery.

Dr. Saber offers a more sensitive, female perspective for patients of all ages, genders, and orientations. Former patients from all walks of life have praised not only their treatment outcomes but her caring, thoughtful approach to a wide array of appearance and health-related matters.
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    Dr. Sepideh Saber, MD, FACS

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  • What patients say about Dr. Saber

    Over 16 Reviews

    I was fortunate to find Dr. Saber after researching board-certified surgeons who specialize in breast cancer reconstruction revision surgery. I knew I was in good hands from the moment I spoke with the lovely and efficient Marlene, Dr Saber's office manager. Dr Saber patiently listened to my concerns and, after examining me, explained what I could realistically expect the outcome to be from another surgery. She also explained to me that she would need to review my previous surgery notes before we could discuss a possible further surgery, which I found comforting and highly ethical. I also discussed a couple of other procedures that I would like done, including fat removal from my large upper arms that had caused me great embarrassment for several years. Dr. Saber is an excellent surgeon who is incredibly kind and genuine. She truly understands the female body and the emotional aspect of body insecurities yet, she is transparent about what can and cannot be done and takes time to discuss realistic expectations and outcomes. My breast reconstruction revision surgery will take place in the New Year, but in the meantime, I have the most fabulous upper arms that I recently flaunted in a strapless dress (something I have not done in years). Dr Saber is truly one of a kind, and I still cannot believe how fortunate I am to have found her. I highly recommend Dr Saber.

    Linda DeCarlo November 29, 2023

    I don’t have enough wonderful words to describe Dr Saber and Marlene! I had a tummy tuck done this year and from start to finish the entire experience was amazing. Marlene is always so helpful and works so hard to make every detail a breeze for you. When I had my consultation with Dr Saber I was at a point of complete agony with my body. She instantly took that stress and frustration off my shoulders! As a woman not being heard by doctors for years I left that consultation with happy tears knowing I had finally found my Dr. It was a major surgery and I felt completely zen and at peace going in because she really does make you feel that safe. I didn’t think I would ever look the way I do now! She gave me the gift of having the body I kept fighting for. I will never stop recommending her.

    Monica Prusa October 9, 2023

    I saw Dr. Saber when I broke my wrist. I ended up having to have surgery. She did an excellent job and I am healing nicely. She was very professional, but was also very kind and compassionate. I would highly recommend her!!

    Sandy Schaupp September 13, 2022

    I LOVED DR SABER!!! There are a few reasons why I chose her. One was because she’s a female Doctor that was my goal who also did a good job (which I was able to confirm with all her before and after photos) and what sold me was my safety in mind. She made me feel like I was in the best hands ever along with Marlene who coordinated everything THANK YOU LADIES! Dr Saber helped me get back the body I have always desired. I had a lot of stomach fat from weight gain and I lost weight so a lot of my weight was in my front lower and upper abdomen. Now I have a super beautiful curvy body like an hourglass after a tummy tuck and lipo she did. She understood the assignment hahaha . I’m 32 years old no kids just wanted to enjoy my younger body looking and feeling beautiful and she really took good care of me. Even after hours I had an emergency due to my fault but she was there and got back to me very quickly and I’m very grateful. I also think her work says a lot because I stopped taking pain medication on the 3rd day after surgery and was fine with very minimal pain I was able to tolerate the healing process. Highly recommend going with her I just had a wonderful experience and would do it all over again if I had too. Maybe after I have kids. Thanks Dr Saber and team <3

    STEPHANIE d July 15, 2022

    Dr.Saber is by far one of the best plastic surgeons. I love how she takes her time to explain any procedure to the patients understanding. She always makes sure to answers any and all questions.From fillers to body contours she’s the one you want.

    Katherine Melara February 15, 2022

    Dr Saber is amazing! She is caring and very informative. I went in for fillers and she explained procedure step by step. I highly recommend her and look forward to future visits.

    Amanda Vazquez December 18, 2020

    Dr. Saber was friendly, knowledgeable and professional. She took time to listen, answer all my questions and was forthright in her recommendations. Her staff was friendly and helpful. I was very happy with the results and plan on going back. If you are looking for a first rate professional experience look no further she is the doctor for you!

    T R December 18, 2020

    Dr. Saber is one of a kind plastic surgeon with a heart of gold. She is a well verse plastic surgeon that puts her patient's needs before anything else. She genuinely cares about every single patient, and her work speaks for itself. I notice every post-operative result on her Instagram (@saberplasticsurgery) the patients have this glow that radiates through. I have been going to Dr. Saber for my Botox for the past 3 years, and love the results every time. I know who I will be going to for any future plastic surgery needs, and will confidently refer family and friends to Dr. Saber for any Botox, fillers, and plastic surgery consultations.

    Rudy Garcia December 16, 2020

    I have nothing but great things to say about Dr. Saber! I am so pleased with my results from a breast augmentation she performed on me back in late June! She answered all my questions and concerns before and after my surgery. She’s very easy to get in contact with and she’s so nice. She made feel so comfortable throughout the whole process. 100/10 Lover her work!!

    Amanda Villegas October 15, 2020

    Dr Saber is hands down the best surgeon! She took her time answering my questions and explained procedure in detail. After doing liposuction six months ago, I am extremely happy with my results and I appreciate her so much.

    Marlene Cosentino October 15, 2020

    Dr. Saber is so kind and thorough with her patients! She is an amazing doctor and genuinely cars about everyone she comes in contact with. I would recommend her to anyone for any hand surgery or cosmetic procedure.

    Rachel Meach October 15, 2020