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Monthly Archives: July 2013

How to Get Insurance to Cover Breast Reduction

Posted on: July 31, 2013
By: DrDelgado

HealthInsurancePapersSan Francisco, CA-Due to all the medical problems that having large breasts, also known as macromastia, can cause (see previous blog), many health insurance policies will cover all or part of breast reduction surgery. However, it is getting more difficult to get approval and with all the changes with health insurance it may become even harder.

In the meantime, if you have a policy that specifically has an exclusion for breast reduction surgery there isn’t much you can do except get a different policy. If you work for a company that offers medical insurance, review all insurance plans offered and switch to one that will cover the cost of breast reduction surgery during the open enrollment period (which is usually in November). The new insurance will probably cost more, but then you can switch back to your previous one at the next open enrollment.

If your insurance does not have an exclusion, that’s a big plus, but you still may have a few hoops to jump through to get approval. Understanding what most insurance companies require and why makes it a little easier to go through the process.

The insurance company will want to know what you have tried to help alleviate your symptoms. For example, have you invested in high quality support bras? For many women, even with top quality bras, they end up with shoulder grooves from the straps whichSupport bra

themselves can be painful. Next, have you tried physical therapy including exercises to strengthen your back muscles to help counteract the additional weight carried on your chest? Have you tried anti-inflammatories to ease back, neck and shoulder pains? It is unlikely that these methods are going to give you any lasting relief, but the insurance company will want to know as they are not anxious to give approval. You can expedite your approval process if you have documentation of all these things ahead of time. Get a letter from the physical therapist, receipts for bras, a letter from your General Practitioner that you have tried anti-inflammatories.

Another requirement some insurance companies have is that you need to be within a certain weight range, and if you are above the limit they may not cover your reduction mammoplasty procedure until you lose weight. This is understandable because for many women when they lose weight they will also lose fat in their breasts, and the back pains may have resolved themselves; therefore, surgery will not be covered. Not only will their breast reduction surgery not be covered, they are left with droopy sagging breasts, and if they desire a breast lift, that won’t be covered either as it is considered cosmetic surgery. Insurance companies will not cover a procedure they consider cosmetic unless it is causing physical pain and/or complications; psychological distress is not considered a reason to cover a procedure, such as gynecomastia, which is male breast reduction.

Losing weight can be very difficult for many women with large breasts as exercising is a challenge. It is important to note that large breasts are not only due to excess fat, for many women it is a combination of fat and tissue and, therefore, losing weight may not make much of a difference.

Having a consultation with a Board Certified Plastic Surgeon who specializes in breast surgery will be your best option. Your surgeon is very familiar with all the ins and outs of the insurance companies and will be able to advise you on the probability of getting coverage.

In addition to all of the requirements mentioned above, one of the main requirements of the insurance company will be how much tissue is needed to be removed. Most say it must be 500 grams per breast or more, otherwise they consider the procedure to be cosmetic in nature, and they will not cover it. Your surgeon will be able to tell you approximately how much tissue you would need to have removed and the probability of your qualifying.

Even after all of these steps have been taken there have been cases where the insurance company has turned down their clients for surgery. While this is extremely frustrating, don’t give up just yet! The next step would be for your surgeon to appeal your case; this can be more successful than you might think. When an appeal is requested, the insurance company brings in an impartial medical doctor to review the case. The doctor will contact your surgeon to discuss your issues. Many times after the surgeon and doctor consult the denial is reversed, and surgery is approved!

Dr. Delgado has had many years of experience with situations such as these, successfully obtaining approval from insurance companies on behalf of his patients.

Macromastia (large breasts) Cause Multiple Problems

Posted on: July 15, 2013
By: DrDelgado

Breast Reduction Before and After

This is a 32-year-old resident of San Rafael, California who was seen in the Novato office in Marin County. She is 5 feet 4 inches, 130 pounds, and underwent a short scar vertical breast reduction at the Marin Cosmetic Surgery Center. Her size was reduced from a size F to a size C. The photographs are seen approximately nine months after surgery and the incisions are starting to fade quite nicely.

San Francisco, CA-Women who have suffered with large breasts will tell you of several conditions that cause them continued misery. Both physical and psychological symptoms of macromastia may affect the quality of life.

Having the extra weight that large pendulous breasts pose, women tend to lean back for support. Leaning back will disrupt the body’s natural support structure around the spine and puts a lot of strain on the lower back muscles which will affect; bending, sports activities and even sleeping. Exercise can be very difficult, jogging with bouncing breasts can be painful and even walking, to the point that many women will avoid exercise all together which will only lead to weight gain and larger breasts.

The resulting poor posture may lead to chronic nerve problems such as numbness and tingling in the arms and hands. Efforts to get extra support from a specialty bra will include large straps may cause grooving into the shoulders, and possible rashes and the extra pressure on the shoulders may result in neck pain.

It is hard to keep the area under large breasts dry which ultimately leads to rashes and yeast infections. In addition, the extra breast weight on the chest may cause breathing difficulties and possible pain in the lungs from the added pressure. However, it is possible that something other than large breasts could be causing breathing problems and needs to be evaluated by your physician.

Unwanted attention from the opposite sex can result in a great deal of mental stress which may lead to low self-esteem and loss of self-confidence resulting in depression and poor quality of life.

Shopping for clothes can be very frustrating and become a chore; it is very difficult to find clothing that fits properly around the chest and then correct for the rest of the body.

Treatment for macromastia without surgery would be with anti-inflammatories, chiropractic adjustments, massage, heat packs, physical therapy, etc. but such treatments rarely will bring lasting permanent relief. Large breasts get progressively heavier with age and gravity.

Fortunately, most insurance companies cover breast reduction surgery for women. Unlike gynecomastia, the condition of breast enlargement for men, where insurance companies will rarely approve male breast reduction surgery.

That is not to say that women won’t have to jump through many hoops to get insurance coverage for their breast reduction surgery, they will, but for a cosmetic plastic surgeon that is used to the ins and outs with the insurance companies, approval can be obtained in most cases. There are exceptions; some insurance companies have a specific exclusion for breast reduction surgery, or they may have a required minimum of breast tissue that needs to be removed. Some insurance companies require documentation of methods tried before approval such as; weight loss, physical therapy, good support bras, analgesics, etc.

In the disappointing event of the insurance company denying coverage, the experienced breast reduction specialist will make an appeal on your behalf. In this case, the insurance companies usually have a medical doctor review the case and speak to the referring physician. I have done this for many patients with the result that approval has been granted on appeal in most instances.

Breast reduction surgery provides one of the highest satisfaction rates with patients experiencing almost immediate relief of symptoms after surgery.

Breast Reduction for Teenage Girls

Posted on: July 1, 2013
By: DrDelgado

Before and After Breast Reduction for Teenage Girl

This is a 19-year-old female resident of San Francisco who presents for a breast reduction. She is 5 feet 2 inches, 130 pounds. At Marin Cosmetic Surgery Center she underwent a vertical short scar breast reduction reducing her size from a DDD to a C cup. She is seen approximately six months after surgery with nicely healing scars.

San Francisco, CA-When young girls start to go through puberty and their bodies start to change, they begin to struggle with self-esteem and body image. They want to be accepted by their friends and can be greatly influenced by the media as to how they think they are “supposed” to look. It is reported that as much as 44% of high school girls are attempting to lose weight. Many girls agonize over breast development worried that their breasts are too small and even try to convince their parents to allow them to have breast augmentation before they have finished developing. Then there is the young woman whose breasts start to grow and seem like they will never stop.

Breast development can start as early as 8 years old or as late as 13. If the breasts continue to grow and become very large, the condition is referred to as juvenile macromastia and even larger breasts juvenile gigantomastia. In the early stage of development, the breast bud will begin to develop. Then the nipple area begins to look a little puffy, but the nipple remains flat. The next stage of development, the breast itself gets a little bigger, and the areola darkens and gets puffier. The hormone estrogen is secreted by the ovaries and is responsible for breast growth. Usually the process for breast development can take 3 to 5 years, but up to 10 years for some. During the time that the breast is developing, girls may experience breast pain and tenderness, and the skin may feel itchy as it stretches.

When the breasts grow too large for a teenage girl, she will most likely suffer physical and psychosocial consequences. The emotional devastation is exacerbated by unwanted attention from classmates leading to destruction of self-esteem and poor body image. Some girls develop such serious psychological problems that it can sometimes even lead to suicide.

Breast size is usually determined by your genes but not always. The amount of body fat versus breast tissue one has can make a difference. If a girl loses weight her and her fat ratio is much higher than the breast tissue, then her breasts may get smaller, although then they may sag as there is not as much fat to fill them out leading to possible breast revision surgery in the future. Teens that are already at a normal weight but want to lose weight in their breasts risk vitamin and mineral deficiency.

Exercise will not make breasts larger or smaller or perkier as there are not any muscles in the breast.

Young girls suffering with large breasts are advised to:

• Stand up straight, hunching over does not hide large breasts but will add to back pain.

• Wear a super supportive bra

• Pick clothing that doesn’t accentuate your breasts, avoid large patterns, horizontal stripes, pencil skirts, and tight jeans

• Avoid necklines that show cleavage

Another option, some girls try to hide their large breasts by using minimizer type bras, while this might help to make the breasts look smaller, the compression can be very uncomfortable and not good for breast health.

The third way some girls seek a reduction of their macromastia is by liposuction, for some this can be a very successful type of breast reduction, but for those with very large breasts, it will only reduce by a small amount. This leaves the most effective way for breast reduction, and that is breast reduction surgery, also known as a reduction mammoplasty. There are risks involved for the younger girl. First, the breast may continue to grow necessitating a second surgery at a future date, there may be loss of nipple sensitivity and the ability to breastfeed may be compromised, and lastly there will be breast reduction scars.

Breast reduction surgery for a teenager is appropriate in some cases, even with the known risks. Almost all women that seek breast reduction surgery state that the removal of the extra weight has freed them of back and neck pain and increased their quality of life, they enjoy having a conversation with people who now look them in the eye.

When parents are aware that their daughter may be facing such a situation, it would be wise to have a consultation with a breast reduction surgeon who is Board Certified in Plastic Surgery to discuss all options and see breast reduction before and after pictures.

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