Breast Reduction or Reconstruction Patient Referral

Most health insurance policies will cover the expense of breast surgery as long as we have documented that other nonsurgical treatments were unsuccessful.  Emory Plastics and Reconstructive Surgery will work with you and health insurance providers to obtain the maximum coverage benefit for your patient.

Standard Breast Reduction Surgery Requirements

Patient must be at least 18 years old.  Most insurance companies will not cover the expense of breast reduction for morbidly obese patients or bariatric patient candidates. Women who are considering plastic surgery are strongly encouraged to quit smoking.

Patient must have two or more of the following conditions (for at least 12 months and after conservative therapy has failed):

  • Pain in the upper back, neck, shoulders, and/or arms, which must be of long-standing duration and increasing intensity.  The pain could not be relieved by at least three months of conservative therapy such as using a  bra with wider straps, exercises, heat/cold treatments, appropriate non-steroidal anti-inflammatory agents or muscle relaxants and physical therapy
  • Dermatitis of the shoulder or shoulder grooving not responding to the treatment of a support bra or dermatologic treatments.
  • Intertrigo between the pendulous breast and the chest wall persisting.
  • Kyphosis, documented by X-ray.Ulnar paresthesia not relieved by at least three months of conservative therapy such as, a support bra with wider straps or physical therapy.
  • Significant asymmetric breasts

Minimum Tissue Removal Requirements

The amount of breast tissue removed from each breast must be at least the minimum in grams per breast for the patient's body surface area, according to the Schnur Sliding Scale.  In cases of significant asymmetry, the combined weight of the tissue removed from both breasts must total at least twice the amount required for the patient's body surface area.

Call 404-686-8143 to refer your patient to an Emory Breast Plastic Surgeon.