Breast Reduction Criteria

Breast Reduction Criteria


For women who suffer from large, pendulous breasts that are disproportionate to the rest of their body, a breast reduction is a solution that may be covered by your medical insurance. Women with large breasts may have symptoms of back, neck, and shoulder pain, headaches, breast pain (especially with exercise), and rashes along the folds of the breasts. Dense breast tissue may also make breast cancer surveillance procedures, such as mammograms and ultrasounds, difficult to interpret.

Who is a candidate for breast reduction surgery?

Due to the health issues associated with pendulous breasts, breast reduction surgeries can often be pursued through a patient’s health insurance. However, patients not approved through insurance may still undergo breast reduction as an aesthetic procedure.

Breast patients commonly have some of the following symptoms:

  • Breast pain
  • Shoulder pain
  • Neck pain
  • Unspecified back pain
  • Lower back pain
  • Intertrigo
  • Poor posture
  • Finger and hand numbness
  • Shoulder notching from bra strap
  • Ptosis breasts
  • Nipple discharge
  • Fibrocystic breasts
  • Breast masses
  • Rash beneath breasts

Treatments commonly used to treat these symptoms may include:

  • Physical therapy
  • Chiropractic
  • Massage
  • Acupuncture
  • Spinal x-rays
  • Electric stimulation
  • Posture training
  • Medications
  • Exercises
  • Cortisone cream or other prescription medication for rash treatment

If you feel that you are a candidate for breast reduction surgery and are requesting coverage under your health insurance, it is important that you contact your health insurance carrier and have them provide their criteria for coverage approval. Each insurance company has different independent criteria and indications for coverage. 

A breast reduction, on average, takes between 3-6 months of preparation, including consultations with other healthcare providers and possible therapy (physical therapy or chiropractic) to qualify for insurance coverage. Notify your primary care physician as soon as possible concerning any of the symptoms listed above which may be related to your breast size. It is never too early to start the process or have a conversation with your physician.

If you have been suffering from these symptoms and are ready to discuss your breast reduction options, schedule a complimentary cosmetic consultation with Dr. Antimarino.