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I’m Getting a Breast Reduction & How To Get The Process Started With Insurance Coverage

I’m Getting A Breast Reduction & How To Get The Process Started With Insurance Coverage

This has been a long time coming. I am finally getting a breast reduction! UPDATE: I did it! Here’s my experience so far.

I have had large breasts for years. Although I was average in high school, it wasn’t until I was in my 20’s when I realized my chest was still growing. I was a b-cup at around 16, then a D when I got married at 26. Then I had hormone therapy for infertility and grew to a DDD before I got pregnant with my twins.

After having my twins 5 years ago my size settled into a small H. No matter what I have done to lose weight my breasts will just not get any smaller. As I continued to live with them I started getting back pain, pinched nerves, lack of sleep, and an overall sense of being constantly uncomfortable. Ladies – having large breasts is AWFUL. To top it off nothing fits me. Every dress is empire waist on me, every top I own is stretchy fabric, zippers don’t zip past my ribcage. It’s depressing.

Some indications that you might need a breast reduction:

  1. Indents in your shoulders from bra straps.
  2. Back pain – upper and/or lower.
  3. Neck pain or frequent muscle cramps.
  4. breast size does not change (or changes minimally) with weight loss.
  5. Sleep issues.
  6. Rash between and/or under breasts.
  7. Breasts not proportional in size to each other.
  8. Mental stress due to breast size (depression or anxiety relating to appearance).

Last December I was contacted by Dr. Ronald DeMars office about doing a feature on “mommy makeovers” – tummy tucks, breast lifts etc. Although the timing didn’t align for me it got my wheels turning. Dr. DeMars is one of the top plastic surgeons in Portland and has an average rating of 4.9 out of 5 across the board on several review sites.

I went in to see Dr. DeMars in May 2015 to find out about getting a reduction. I felt instantly at ease in his office and with him and the staff. He explained the procedure and what to expect for recovery well. After looking at the before/after look-book I am confident I have the right surgeon for the job.

Want to know how to get started? Here’s what my process looks like so far:

1. Check with your insurance.

You will want to check with your insurance to find out how to qualify for a covered reduction mammoplasty. The insurance code for this is 19318, although your code might be different. Some insurance companies might require you to have non-evasive treatment such as physical therapy or medication. Most require a certain height/weight maximum. I am 175lbs and 5’6″ and fell into the “medically necessary” category for a reduction, but it all depends on your body type.

2. See your primary care doctor first.

You primary care doctor will determine the need for a reduction and start the necessary paperwork and requirements for your surgery. You should also get a breast exam at your appointment.

3. Get a mammogram.

Most insurance companies will require you to get a mammogram depending on your age. If you are younger it may not be necessary, but check with your insurance. You should get results within a few days.

3. Consult with a surgeon.

There are many great plastic surgeons out there, but the most important thing is to do your homework. Make sure your surgeon is board certified and has their specialty in plastic surgery. Your best bet is to start with a reputable plastic surgery practice in your area or get recommendations from other patients. Check out sites like The American Society of Plastic Surgeons, Real Self, Yelp, Google Reviews, etc. Make sure you find a good one.

The consultation will usually consist of a conversation as to why you want a reduction, previous health issues, a physical exam, an educational video, and talking with the office manager about fees and insurance.

4. Submit to insurance and wait!

The surgeon’s office will actually do this for you. The process usually takes about 6 weeks or so, so be patient! Your insurance will come back with 1 of 3 answers:

  1. Denied. Lame. But they will tell you why.
  2. Approved. YAY
  3. Need more information.

You will get a letter in the mail with one of these 3 answers. When you get it call the surgeon’s office for more information.

5. Schedule your surgery!

Your OOP (out of pocket) will be based on your coverage, your maximum deductibles, etc. You will find out all of this when insurance is billed.

My surgery is officially scheduled for November 11! Keep this page bookmarked for updates!


Katie plucker

Saturday 12th of January 2019

Horrible back and neck pain and migraines... starting to think this might be the answer. Not sought much treatment for except massages and chiro. Appear same frame 180, 5’6 I’m a 34 g. Used to be a c in high school. No kids... gain weight gained boobs. Loose weight still have boobs. Poor launches over shoulder posture.. hoping I can learn more. Husband a little afraid of scarring....


Saturday 12th of January 2019

Hey Katie! I would definitely recommend starting by going to your primary care doctor first about the complaints - most insurance companies will require this anyway and he/she can give a referral for a plastic surgeon. As far as scarring goes it really depends on your skin type. As you can see I am very fair and my scars end up fading. As of now I can hardly tell - there is a raised line under each breast but and on my breasts it's so minimal I don't even see them. I would examine some of your other scars you may have to gauge how much they fade on you. I can tell you that probably for the first year the scars were more pink but like I said have all but faded now. Your comfort is worth more than a few tiger stripes ;) Good luck!

Jennifer roman

Sunday 7th of October 2018

Hi! I have needed a breast reduction for some time. It’s bad to wear I have all of those listed above along with my vertebrae at the top bulges out due to my posture. I feel so so uncomfortable with myself and my back and neck hurt constantly.. sleep is never good causing me to be cranky. I am curious as to how many sizes one should go down and also about the healing process. Is it really painful and how long to be able to get doing daily things again? Thank you all!!


Thursday 11th of August 2016

How long were you off work? I travel and may have to push large machines.

Liana Feldman

Monday 11th of April 2016

I got my breast reduction done 6 months ago and it was the best decision I,ve made. I can wear tops that i couldnt before, I can wear shirts braless, bras dont cause me pain, back and neck pain gone immediately, and bikinis finally fit! No nip-slips! I recommend Dr. Robert Applebaum located in Beverly Hills, California. My insurance covered it 100 percent I was DD-DDD 5'4 130 pounds 19 years old. If you are considering it I say go for it:)


Monday 14th of March 2016

Hey Carol! I wanted to get a breast reduction before I'm off my parent's insurance. I was wondering how payments worked? Are there just the hospital bills?


Monday 14th of March 2016


It's really up to the doctor's office, since they are all different. My personal experience was that my Dr (Dr DeMars in Portland) was considered "out of network" and so they accepted to lowest amount from my insurance, so I had no out of pocket there, but I did have a small bill from the anesthesiologist, but his services were in-network because he came over from the hospital across the street. Traditionally you would get the pre-approval taken care of and your doctor's office/billing manager will let you know if there is anything left due before the surgery, so you can work out the payments with them :) Get the process started ASAP so you can hopefully get it covered since it can take a while :) Good luck!!