Breast reduction

Requesting coverage may be appropriate when reduction has a therapeutic purpose, such as breast hypertrophy with symptoms and limitations. This differs from reduction requested solely for aesthetic preference. However, a diagnosis or medical report alone should not be presented as an automatic guarantee of authorisation.

The request should describe symptoms, examination findings, previous treatments when relevant and the purpose of surgery. The medical indication is based on the clinical situation, while coverage depends on the rules applicable to the contract, procedure and individual circumstances.

For treatments outside the ANS coverage list, the judgment in ADI 7.265, in 2025, established cumulative criteria. It is therefore inappropriate to claim that absence from the list can never justify a refusal or that any medical indication requires coverage regardless of other conditions.

The team can provide clinical documentation. Questions about authorisation, provider networks, fees and reimbursement should be clarified with the insurer in advance and, when necessary, with legal advice. A functional purpose alone does not mean full cost coverage with any provider.

References

1. Perdikis G et al. American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty. Plast Reconstr Surg. 2022;149(3):392e–409e. DOI: 10.1097/PRS.0000000000008860. View reference.

2. Brazilian Supreme Federal Court. STF establishes criteria for health plans to cover treatments outside the ANS list. 18 September 2025. ADI 7.265. View reference.

Breast reduction may improve pain and limitations related to breast weight. This benefit is recognised in the ASPS guideline for symptomatic hypertrophy, but does not mean treating every cause of back or neck pain.

In a Brazilian trial, 100 women were allocated to surgery or a waiting list, and 46 in each group completed assessment. After six months, average pain on a 0–10 scale in the surgical group fell from 5.7 to 1.3 in the lower back, from 6.1 to 1.1 in the shoulders and from 5.2 to 0.9 in the neck. Functional improvement was also observed. These are averages from a selected group, not a guarantee of the same pain reduction for everyone.

Before surgery, I assess the pain pattern, bra-strap marks, skin irritation and difficulties with activities. Spinal disease or another independent cause may need its own treatment and may partly persist after reduction.

The expected benefit is individual: surgery may reduce the breasts' contribution to symptoms without promising that all pain will disappear. Indication need not be reduced to a fixed number of grams to remove.

References

1. Perdikis G et al. American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty. Plast Reconstr Surg. 2022;149(3):392e–409e. DOI: 10.1097/PRS.0000000000008860. View reference.

2. Freire M et al. Functional capacity and postural pain outcomes after reduction mammaplasty. Plast Reconstr Surg. 2007;119(4):1149–1156. DOI: 10.1097/01.prs.0000254358.55104.9f. PMID: 17496584. Randomised trial. View reference.

Sensation and the ability to breastfeed may change. Because reduction removes and rearranges tissue, this should be discussed before surgery, particularly if you plan to have children.

Sensation: planning aims to preserve nipple blood supply and nerves, but recovery varies. Sensation may decrease, increase or remain altered. No pedicle guarantees preservation in every case, and study percentages depend on the technique and how sensation was measured.

Breastfeeding: some women retain milk production, but the amount may be insufficient for exclusive breastfeeding. Preserving connections between the nipple, ducts and glandular tissue matters. Monitoring the baby after birth remains essential.

In selected cases of very extensive reduction, a free nipple graftmay be considered. This technique completely detaches the nipple and replaces it as a graft, interrupting its original connections. It has significant implications for breastfeeding and sensation that need specific explanation during consent.

If breastfeeding is a priority, we will discuss both the technique and whether to postpone surgery. Function cannot be guaranteed simply by the name of the chosen technique.

References

1. CDC. Breast Surgery and Breastfeeding. Clinical guidance on lactation after breast surgery. View reference.

2. Perdikis G et al. American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty. Plast Reconstr Surg. 2022;149(3):392e–409e. DOI: 10.1097/PRS.0000000000008860. View reference.

The amount depends on initial volume, symptoms, anatomy and the desired outcome. It is estimated during planning and may need adjustment during surgery to protect tissue safety.

The ASPS guideline advises against basing symptomatic reduction solely on tissue weight removed. A threshold such as 500 grams per breast is not a universal clinical requirement: patients with different volumes and body types may have significant symptoms.

Reduction must also preserve tissue circulation and plan nipple repositioning. Large reductions may require specific strategies and have limitations that need discussion. The goal is to balance relief, shape and safety, rather than remove as much as possible.

The estimated amount should not be presented as a guarantee of final clothing size. Clinical criteria also do not automatically match an insurer's authorisation rules.

References

1. Perdikis G et al. American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty. Plast Reconstr Surg. 2022;149(3):392e–409e. DOI: 10.1097/PRS.0000000000008860. View reference.

Reduction usually leaves scars around the areola and a vertical line down to the breast crease; in many cases, a horizontal line is added, creating an inverted T.

The pattern depends on excess tissue distribution, skin and the chosen technique. There is no rigid rule linking a particular weight to one incision type. Planning must allow appropriate reduction and reshaping.

Scars are permanent. They may become redder and firmer before fading, but quality, width and pigmentation vary. A tendency towards raised scars and previous healing problems should be reported.

I show the expected incisions and explain care. Seeking a shorter scar is reasonable provided it does not compromise necessary removal or tissue circulation. It is impossible to guarantee that every line will be hidden by every style of clothing.

References

1. Perdikis G et al. American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty. Plast Reconstr Surg. 2022;149(3):392e–409e. DOI: 10.1097/PRS.0000000000008860. View reference.

2. ASPS. Breast Lift Procedure Steps. Institutional guidance. View reference.