ASPS Issues Recommendation For Insurance Criteria for Breast Reductions

ASPS Issues Recommendation For Insurance Criteria for Breast Reductions

Breast reduction has been viewed as a procedure between a cosmetic and a reconstructive surgery. In some cases, insurance companies may cover this surgery, but there has been controversy regarding coverage. ASPS has now addressed insurance coverage for this procedure outlining possible criteria for coverage.

The justification for a reduction mammoplasty should be based on the likelihood of relieving clinical signs and symptoms of breast hypertrophy. Because it is difficult to determine the size at which symptoms become a problem, the ASPS position has focused not on the amount of tissue removed or the initial size of the breast, but the degree of symptom relief.

Symptoms from breast hypertrophy usually center around shoulder pain, painful shoulder grooving from bra straps, and/or a rash underneath the breasts, as well as headaches, backaches, etc. Conservative therapies have been found to be ineffective in providing significant relief, and there are no studies confirming the cost-effectiveness of conservative care as a first line of therapy.

There has been good scientific evidence indicating the reduction mammoplasty is effective in treating related symptoms from breast hypertrophy and improvement in overall quality of life. Evidence has indicated that women across a wide range of breast sizes may experience similar relief of symptoms following a reduction mammoplasty.