It depends on why you’re asking for it
Insurance companies look for medical reasons. Not just cosmetic ones. If your breasts cause back pain, shoulder grooves, rashes under the fold, or posture problems—you may qualify. But you’ll need more than words. You’ll need proof.
Photos. Doctor notes. Documentation of symptoms. Sometimes physical therapy records. Sometimes dermatology visits. They want to know you tried other options first. That surgery isn’t just a wish—but a medical need.
It’s not about how large your breasts are. It’s about how they’re affecting your health.
Every plan has its own list of requirements
Some insurers demand a minimum amount of tissue to be removed. A certain number of grams. Based on height, weight, body surface area. If your expected reduction falls under that, they may deny coverage—even if you’re in pain.
Others focus on documented symptoms. Some require letters from multiple physicians. Some require a BMI under a certain number. The details vary. But the paperwork always matters.
It’s not just about the surgery—it’s about fitting their definition of “necessary.”
A consultation with a plastic surgeon starts the process
A board-certified plastic surgeon will evaluate your symptoms, measurements, and goals. They’ll estimate how much tissue would be removed. They’ll take photos. Write a detailed note. Submit it to your insurer.
Sometimes it’s approved right away. Sometimes not. Appeals are common. Many patients are denied at first—then accepted after more documentation.
That first visit is more than a consult. It’s the beginning of a paper trail.
You may need to try other treatments first
Insurance companies often want to see conservative treatment. Did you try physical therapy? Did you lose weight? Use special bras? Take pain medication? See another specialist?
You may be asked to prove you followed those steps. Even if they didn’t help. Even if surgery is the only real fix. They want to check boxes before they approve the one solution that works.
It can feel frustrating. But it’s often part of the process.
Cosmetic goals are not enough for approval
If you just want to feel smaller. Or look more proportionate. Or fit into clothes. That’s valid. But insurance won’t pay for it. They cover function—not aesthetics.
That’s why wording matters. Why documentation matters. If you only say, “I want to look better,” you may get denied. If you show chronic pain, failed treatment, and medical need—you stand a better chance.
Language becomes the bridge between your pain and their policy.
Pre-authorization doesn’t guarantee final coverage
Even if your surgery is pre-approved, insurers can still review the final report after the procedure. If the actual tissue removed doesn’t meet their number, they may deny full coverage.
That’s why surgeons often overestimate—just slightly. To give margin. To avoid surprise bills. It’s not manipulation. It’s reality.
Knowing the rules protects you before you even get to the operating room.
Appeals are common—and sometimes necessary
If you’re denied, it’s not the end. You can appeal. With new letters. New documentation. New test results. Many patients are approved on the second or third try.
Surgeons’ offices often help with this. They know the system. They’ve seen it before. They know which phrases trigger approval.
Persistence matters more than perfection.
Some people choose to pay out of pocket
If you don’t meet criteria. Or don’t want to wait. Or want a specific surgeon who’s out of network. You can still have the procedure. Just not through insurance.
Prices vary. From $7,000 to $15,000 or more. Depending on location. Surgeon. Hospital fees. Anesthesia.
For many, it’s worth it—even without coverage.