Reduction mammaplasty: criteria for insurance coverage

The guidelines by which insurers determine eligibility for coverage of reduction mammaplasty must rely largely on only subjective materials, yet they often apply strict criteria ranging from minimum resection weights to outright refusal to compensate. I have reviewed the data from 100 consecutive reduction mammaplasties performed by me over the last 2 years. Body weight, combined specimen weight, and height relationships were studied. Patient-identifiable questionnaires regarding the presence or absence of preoperative regional discomforts were sent to the same group. It was not possible to construct a useful formula that would verify either subject complaints of discomfort or the prospect for their relief based on body dimension or specimen weight. This study suggests that a graded, three-level minimum specimen weight standard for body weights less than 70 kg, 70 to 79 kg, and over 80 kg would be more equitable.