Breast Reduction: Practicalities

Can Insurance Cover My Breast Reduction? Here’s What You Need to Know

Breast reduction surgery can be life-changing—but the decision to undergo it is often complicated by the question of cost and insurance coverage. The good news? Some patients are eligible for breast reduction through their insurance provider. Here's how the process works—and what to expect.

Medical Necessity: What Insurance Companies Look For

To be considered medically necessary, a breast reduction typically needs to address symptoms that significantly impact your daily life. These may include:

• Chronic back, neck, or shoulder pain
• Deep grooves in the shoulders from bra straps
• Rashes or skin breakdown beneath the breasts
• Psychological distress or body image concerns related to breast size

If you’re experiencing these symptoms, your case may meet the criteria for insurance coverage.

How Much Needs to Be Reduced?

One of the main tools insurance companies use to determine eligibility is called the Schnur Scale. This scale uses your height and weight to calculate a minimum amount of breast tissue (measured in grams) that must be removed for the surgery to be deemed medically necessary.

While many surgeons and patients feel the Schnur Scale has limitations, it’s still widely used to predict whether your procedure will be covered. I’ve linked a Schnur Scale calculator here for your convenience.

Denials Happen—And They’re Often Frustrating

Unfortunately, the insurance process can be inconsistent and opaque. Even with clear documentation and symptoms, some patients are denied coverage. If this happens to you—or if you suspect you won’t meet the insurance company’s requirements—we still want you to know there are options.

You can absolutely move forward with breast reduction as a cosmetic (aesthetic) procedure. We’ll work with you to develop a surgical plan that meets your goals and enhances your quality of life—whether or not your insurance comes through.

Final Thoughts

If you're considering breast reduction and wondering about insurance coverage, schedule a consultation with us. We’ll help you assess whether you may qualify under your plan’s medical necessity criteria—and if not, we’ll guide you through your options for a self-pay aesthetic procedure. Relief and confidence are within reach, either way.