The Weight and Cost of Heavy Breasts: A Starter Guide to Breast Reduction Surgery
Large, heavy breasts negatively impact women’s health and lives. Excessive breast tissue, or macromastia, can cause back, neck, and shoulder pain, hand, and arm numbness from impact on nerves, abrasions or indentations on the shoulders from bra straps, and skin infections under the breasts, among other problems. There are often uncomfortable social implications to being large-breasted, as well, and it not uncommon for these women to have emotional, in addition to physical, distress. Thankfully, there is an elective surgery designed to eliminate redundant, healthy breast tissue, known as a breast reduction, or reduction mammoplasty. Tens of thousands of patients elect to have this procedure each year across the United States, and it is performed by plastic surgeons. Breast reductions generally do not require an overnight hospital stay or a lengthy absence from work (depending on the type of work), the complication rate is low, and the patient satisfaction rate is high.
Great! So, what’s the hold-up?
Cost.
Proving the medical necessity of undergoing breast reduction to health insurance companies can be arduous. After all, these are healthy breasts; they are just too big. It is often a challenge to argue a causal relationship between the breast size and the secondary skeletomuscular, nerve, or skin problems the patient is experiencing. Unlike other breast surgery that is designed to remove or reduce the risk of breast cancer, such as mastectomies or lumpectomies, breast reductions are considered cosmetic. They are performed by cosmetic experts, Plastic Surgeons, instead of by General Surgeons who subspecialize in oncological breast care. Please note that for transgender individuals looking to remove breast tissue for masculizing chest surgery, the insurance requirements will be totally different than for breast reductions.
In the way that breast reductions are performed, a natural lift, or mastopexy, also occurs, which treats any drooping, or ptosis, of the breasts that has occurred through childbearing or aging. Often patients also elect to have some sculpting done of their armpit area and undergo liposuction of the axilla at the same time. So, while the goal of breast reduction is to alleviate the physical and mental strain associated with excessive breast tissue, it also does have aesthetic advantages; postoperatively patients look more proportional, they have an easier time finding clothes that fit, and they often feel more at ease in their bodies.
Each patient is unique, of course, as are the requirements for health insurance companies. In general, for insurance policies to agree to help cover the procedure, they are looking for a high breast to body ratio. There are actual formulas, using breast measurements and BMI, and if a patient is deemed generally overweight, they might require evidence of attempted weight loss. Insurance also wants to see medical evidence, from multiple physicians, showing how severe the problems are and that the patient has done everything she can to fix these issues before turning to surgery. Has she undergone physical therapy? Has she had imaging to rule-out any other issues? Has she utilized any specialized braces or garments? In most cases, any supplemental care from massage therapists, chiropractors, or acupuncturists does not qualify as evidence. Also, the breasts must be large enough that a certain amount of weight can be removed during surgery. It varies by insurance, but anything from 200-800 grams of breast weight might need to go. For reference, one cup size is around two-hundred grams.
Pari Alexander is the Practice Manager for Dr. Roy Kim, a Plastic Surgeon in San Francisco. She says that “It can be very difficult to get your procedure covered by insurance. I always recommend patients reach out to their insurance company to get all the info regarding the requirements. I also urge patients to be patient and prepared for a long process. Often patients must undergo other treatments, such as physical therapy, that must be done for 6 months prior to attempting to get a breast reduction approved.”
Clearly, the intent for insurance is to avoid covering breast surgery purely for aesthetics. They want definitive proof that postoperatively, patients will feel and function better, and that their maladies are related to their breasts. This imposes a challenge to patients. Some who are desperate for relief may be rejected. They may have gone through years of pain and therapy, before concluding that their issues sprung from their large breasts. If along the way, no healthcare provider suggested and documented, that the breast size might be the problem and that a reduction might help, the patient may be stuck trying to pay for the surgery out of pocket.
What is the cost, if patients are un-insured or their insurance companies refuse to cover the surgery? Cost varies widely, geographically, and by surgeon’s experience and demand, as well as surgical facility’s prices. According to the American Society of Plastic Surgeon’s, in 2020, the average surgeon’s portion of a breast reduction, when paid out of pocket, was $5,913, which does not include facility and anesthesia costs. The final cost can easily be more than double that.
So, is it worth it? And how does one determine their goal breast size after surgery?
Dr. Kim, who, in addition to having a thriving surgical practice, is a member of The American Society of Plastic Surgeons, The American Society for Aesthetic Plastic Surgery, and the California Society of Plastic Surgeons, says breast reductions can be life changing. “Breast reduction is usually a procedure that patients LOVE. I carefully counsel patients on the final volume of their breasts. Typically, even if patients want a smaller cup size, since they are used to very large volume breasts, I typically do not recommend anything smaller than a C or large B cup, since this will fit the frame of most patients. Each patient is different, so it’s key to get the sizing correct before any surgical procedure.”
Ms. Alexander agrees. “When a patient comes in for their breast reduction consultation versus when they come in for their follow-up, after their breast reduction- they could be two different people! The confidence and relief a patient gains after their procedure is palpable. Most patients are excited for their new futures and extremely grateful.”
Women who think that their health and life might improve with a a breast reduction, first must consider their personal factors. Breasts often change dramatically with pregnancy and breast-feeding, so if planning to carry children in the future, it might be best to wait to do the reduction until after childbearing. Also, not everyone can breast feed after a reduction, so that must be considered before going under the knife. Also, breasts must be determined to be healthy, and cancer-free, so personal and family health risks will be assessed, and imaging (mammogram or other) will likely be requested.
All surgeries come with the risk of infection and injury, and breast reductions are no different. Individuals who smoke or have poor nutrition have an increased risk of complications, as the blood supply of the areola/nipple and skin of the breasts may be more compromised, leading to potentially unhealing areas of the incision, even death, or necrosis, of some of the tissue. The surgeon and anesthesiologist obtains complete medical, surgical, and social histories for each patient to determine their unique risks. Preparing for any surgery involves optimizing nutrition and fitness and being well-hydrated, and postoperatively, resting and recovering and abiding by the necessary restrictions. In this case, that means wearing a supportive garment for a time, avoiding lifting heavy weights, and limiting certain activities. These restrictions and recommendations will vary by surgeon.
It’s important to find a reputable surgeon with an amazing staff who is experienced in the procedure and in navigating the insurance maze. In the end, if breast weight and size is causing a woman physical or psychological pain, she is otherwise in good health, and can afford the procedure, with or without the help of insurance, a breast reduction is a great solution.
Sarah Zimmerman is a freelance writer in Northern California and is working on her first novel. In past lives,, she has been a Physician Assistant in Women's Health and the owner of a vegan ice cream business. Sarah writes about marriage, sex, parenting, infertility, pregnancy loss, social justice, and women's mental and physical health, always with honesty and humor. She has written for Ravishly, Cafe Mom, Pregnant Chicken, and more and can be found at sarahzwriter.com and on Medium, Twitter, Facebook, Instagram and TikTok at @sarahzwriter.