Breast Reduction Surgery Cost and Coverage Options - GoodRx (2024)

Breast reduction surgery – also known as reduction mammoplasty — removes excess breast tissue. This procedure may be performed because of medical necessity or for cosmetic reasons.

People opt for breast reduction surgery for various reasons, including:

• Macromastia: Macromastia, also known as breast hypertrophy, is when the weight and size of the breasts cause physical pain, emotional distress, and reduced quality of life.

• Breast reconstruction following mastectomy: This may mean creating symmetry with the reduction of one breast, following the other breast being reconstructed after cancer surgery. Or it may involve the reduction of both breasts following cancer surgery on one or both breasts.

• Gynecomastia: Gynecomastia is breast tissue enlargement or overdevelopment in males.

• Chest masculinization: Chest masculinization, or top surgery, is breast tissue removal for the purpose of gender affirmation.

• Cosmetic concerns: In some cases, breast tissue is reduced solely for appearance purposes.

What is the cost of breast reduction surgery?

Based on various estimates, the cost of breast reduction surgery in the U.S. can range from less than $5,000 to $19,000 or more without insurance.

MDsave, a price-shopping tool for people without insurance and those who have high-deductible health plans, reports that the estimated national average cost of breast reduction surgery is $33,107 The site also reports that regional savings through MDsave’s participating surgeons drops the average price to $12,110.

According to CareCredit, a health financing company, breast reduction surgery costs in the U.S. range from $2,768 to $19,000. And the American Society of Plastic Surgeons reports $6,771 as the average surgeon’s fee for a cosmetic breast reduction among their members.

The cost of breast reduction surgery can be impacted by:

• Insurance status, coverage details, and negotiated prices

• The type of facility where the procedure performed, with ambulatory surgery centers typically costing less than hospital outpatient departments

• The type of reduction procedure

• Whether the reduction is combined with another procedure, such as a cosmetic breast lift

If you have insurance, your out-of-pocket costs will depend on your plan benefits and whether you use in-network providers.

What other factors affect the cost of breast reduction surgery?

Beyond the surgeon’s fee, there are other expenses that can add up before, during, and after breast reduction surgery. These can include charges for:

• Initial consultation

• Mammogram

• Facility fees

• Anesthesia

• Medications

• Recovery items such as a surgical bra or other support garments

• Additional procedures, such as a breast lift

Women who are age 40 or older typically need to provide a current mammogram to their surgeon before the procedure. But this can be a requirement regardless of age.

What follow-up care is needed after breast reduction surgery and how much will it cost?

Keep in mind that there may be out-of-pocket costs related to your recovery. These expenses may include:

• Costs related to complications, such as issues with wound healing

• Transportation to and from follow-up appointments

  See Also

  Breast Reduction Surgery Guide | ABCS

• Lost income from time off from work, which can be more significant if you have complications

• Child care costs

Does Medicare cover reduction mammoplasty?

Medicare covers breast reduction surgery if the procedure is deemed medically necessary. This is true whether you’re covered by original Medicare or Medicare Advantage.

For Medicare to cover your breast reduction surgery, you need to have been diagnosed with or have experienced one of the following symptoms, conditions, or circ*mstances:

• Skin changes such as inflammation, infection, bleeding, chronic moisture, and/or rashes

• Shoulder grooving with skin irritation despite wearing an appropriate support garment

• Back, neck, and/or shoulder pain that has interfered with daily activities for at least 6 months

• Significant arthritic changes in the spine that have interfered with daily activities for at least 6 months

• Breast reconstruction for one or both breasts following a medically necessary mastectomy

If you have original Medicare, your plan will cover 80% of breast reduction surgery costs after you meet your Part B deductible, leaving you responsible for 20%. Your financial responsibility will depend on the specifics of your plan if you have Medicare Advantage.

Insurance coverage other than Medicare

In addition to Medicare, most other insurance carriers cover breast reduction surgery that’s considered medically necessary. This means the reason for the surgery can’t be cosmetic. Here’s how other plans cover breast reduction:

• Medicaid: Breast reduction coverage through Medicaid varies by state and territory. Check with your local Medicaid office for more information about your benefits.

• Private insurance: Private insurance plans typically cover breast reduction that’s deemed medically necessary, though there may be some conditions. For example, this Blue Cross Blue Shield policy requires a certain amount of breast tissue removal or documentation that supportive garments or other measures have failed to reduce long-standing pain caused by large breasts.

• Tricare: Tricare will cover reduction mammoplasty with documentation that the procedure is medically necessary, for instance in cases involving upper back and neck pain or shoulder grooving because of breast size.

How to get breast reduction surgery covered by insurance

Insurance plans typically require a prior authorization, or an approval of coverage in advance, for a breast reduction. This process typically requires a letter of medical necessity from a physician.

For example, Wisconsin’s Medicaid program requires physician documentation confirming:

• The symptoms are likely caused by enlarged breasts.

• The symptoms have continued despite at least 3 months of measures such as physical therapy.

• The surgery is likely to improve symptoms and lessen discomfort.

How can I afford breast reduction surgery without insurance?

Here are some strategies that can help you afford breast reduction surgery:

• Shop online for prices. Price estimation tools provided by hospitals and other healthcare facilities can help you calculate your costs in advance. Thanks to hospital price transparency rules, hospitals are required to publish standard charges for services that can be scheduled.

• Ask for a good faith estimate (GFE). If you are self-pay or don’t have insurance, you can request a GFE from the hospital or surgical center where you plan to have your procedure. If the final bill is $400 or more above the GFE, you can contact your facility or provider to request that your bill is lowered to match the estimate or discuss a negotiated price. You also should ask if you're eligible for any financial assistance programs.

• Look into financing options. If you’re paying out-of-pocket, you may need help financing your surgery. Medical credit cards and other healthcare financing options allow you to pay for your procedure over time. And some surgeons and practices have relationships with medical financing companies.

• Ask about payment plans. Some surgeons and practices offer payment plans to help you afford surgery.