Breast Reduction for Neck and Back Pain

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Neck and back pain is one of the most common complaints to primary physicians by patients all over the world. Fortunately, neck and back pain typically resolves with or without treatment in two to three weeks. Many patients, however, do not obtain relief in that time. These patients often require a diagnostic work up which may include CAT Scan, MRI, or nerve conduction studies to look for a pathological explanation for their pain. If pathology is found, the appropriate medical or surgical recommendations can be made. Unfortunately, many patients do not find a medical reason to explain their neck and back pain and are left to either suffer with it or live on pain medications.

Recognizing the contribution of hypermastia (heavy breasts) to neck and back pain begins with primary care physicians and chiropractors as these are frequently the first line of clinicians who hear these complaints for patients. The second most important point is knowing that surgery is an option to treat these patients by having a reduction mammaplasty (breast reduction) by a plastic surgeon. Knowing that surgery is an option should prompt a referral to a plastic surgeon who will evaluate if the patient is a candidate.

Breast reduction surgery may be covered by your health insurance, but not all insurances offer benefits for this procedure. All consultations for evaluation of the condition are covered by health insurance. After patients are evaluated by a plastic surgeon, photos of the breast along with a letter explaining medical necessity are sent to the insurance company for evaluation. They then determine if the patient meets their criteria for the requested surgery. The most difficult situation is the patient who falls just under the removal requirement set by the insurance company. Insurance companies all have different criteria and are based on BSA and predicted weight removal of the breast. For example, insurance company A may require 500 grams be removed from each breast of a patient who is 5 foot 5 inches and 70 kg. Insurance company B, however, may require 600 grams be removed from a patient with the same weight or height. If the insurance company denies the procedure, the patient may consider paying out of pocket or using an HSA for the procedure.

The lack of standard in determining benefits and coverage of breast reduction by insurance companies is financially driven. Insurance companies argue that the procedure is cosmetic if the criteria are not met, and cosmetic procedures are obviously not covered. Those that meet criteria usually fall into statistical significance that the insurance company will end up paying more for the nonsurgical care than if they paid for the surgery itself. Insurance coverage and benefit explanations refer to the Schnur scale as a guideline to determine medical necessity. The scale, however, is misrepresented by insurance companies. The scale determined that if a patient was above the upper 22nd percentile in breast weight to be removed, they were a candidate for surgery because medical necessity was proven. The scale also showed that if they were below the lower 22nd percentile, medical necessity was not proven because the patient was typically seeking surgery for cosmetic reasons. The misrepresentation lies in the interpretation of patients falling between these two groups. The Schnur scale showed that patients in the middle percentiles required further investigation because some were cosmetic, and some were medically necessary. Insurance companies, however have lumped this group with the cosmetic group and deny them for surgery.

Breast reductions surgery is a viable option when neck and back pain are from hypermastia. In fact, surgery, not weight loss, is the only effective treatment for neck and back pain when hypermastia is the culprit. Improvements in neck and back pain are typically seen within weeks after reduction mammaplasty.