Tue 19 Jan 2010
When I started my practice a decade ago, most of my breast reductions were covered by insurance. I think they are a great surgery, improving posture, neck pain, back pain, shoulder notching, and the ability to go jogging.
Things have changed.
Now almost none of my reductions can get covered. It is frustrating for me and my patients, as I see many large breasted women who can’t get covered. What changed?
First, I now do a short scar breast reduction technique, called a vertical breast reduction. I “cut out” less breast tissue with this technique. Why did I change? First and foremost: much shorter scar. Also, I find this breast reduction better at shaping, with a longer lasting result. I love it. But with this technique I do liposuction of the lateral breast in the armpit area. Insurance won’t include this fat as part of my “breast tissue removed” total.
Second, the amounts they require have gotten higher. Not a good combo with my short scar technique where the amounts I directly cut out went down anyway.
The Schnur scale came out of a study in the plastic surgery literature. They did the study to prove breast reductions objectively, medically IMPROVE symptoms. During the 1980s plastic surgeons started to see insurance companies refusing to pay for breast reductions, calling them “cosmetic.” So multiple studies followed, documenting scientifically that back pain, neck pain, and breast pain had about an 80% improvement after surgery. (And patient satisfaction was around 90%. Pretty fantastic, particularly given those were the days of the longer anchor scar.)
The Schnur study came up with a scale used to show the volume which needed to be removed for breast reductions done for medical reasons only. The issue is the Schnur study had a mean height of patients being 5’4″, 163 pounds, and a mean total amount of breast tissue being removed was 1515g. (That is over 3 pounds per breast.)
Ug. When I started my practice, if a woman was going down about 2 cup sizes, they would get covered. I used to have to remove about 300g for insurance coverage. Now it is adjusted to the body surface area, and the required amounts have gone up. With current recommendations, a 5′6″ woman who weighs 140 pounds needs a reduction of 370-400 grams per breast to be covered. If she weighs 160, she would need about 450 grams per breast. Liposuctioned fat cannot be applied to this total. In my office I can show you visually what “volume” (using an implant sizer) this would be. Many times the amount looks like the total of the entire breast, essentially being a mastectomy.
You don’t need to convince me a breast reduction and lift is a good idea. Insurance is another story though.
BODY SURFACE AREA CALCULATOR at http://www.bcbst.com/providers/calculator.asp
SCHNUR SLIDING SCALE at http://www.bcbst.com/mpmanual/The_Schnur_Sliding_Scale_chart.htm