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Reduction mammaplasty: criteria for insurance coverage

M W Seitchik1

  • 1Department of Surgery, Medical College of Pennsylvania, Philadelphia, USA.

Plastic and Reconstructive Surgery
|May 1, 1995
PubMed
Summary

Insurance coverage for reduction mammaplasty often uses subjective criteria. This study suggests a graded minimum specimen weight standard based on body weight for more equitable insurance eligibility for breast reduction surgery.

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Area of Science:

  • Plastic Surgery
  • Health Economics

Background:

  • Insurance guidelines for reduction mammaplasty coverage rely heavily on subjective assessments.
  • Current criteria, including minimum resection weights, can be overly strict, leading to coverage denials.

Purpose of the Study:

  • To evaluate the relationship between patient body dimensions, specimen weight, and preoperative discomfort in reduction mammaplasty.
  • To propose a more equitable standard for insurance eligibility for breast reduction surgery.

Main Methods:

  • Analysis of data from 100 consecutive reduction mammaplasty patients.
  • Study of correlations between body weight, specimen weight, and patient height.
  • Use of patient questionnaires to assess preoperative regional discomfort.

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Main Results:

  • No reliable formula could be established to predict patient discomfort or relief based on body dimensions or specimen weight.
  • Objective measurements did not correlate strongly with subjective patient complaints.

Conclusions:

  • Current subjective criteria for insurance coverage of reduction mammaplasty are inadequate.
  • A graded, three-level minimum specimen weight standard, stratified by body weight, is proposed for more equitable insurance coverage decisions.