Breast Reduction Surgery
Breast reduction is considered a reconstructive breast surgery by some, while others classify it as cosmetic surgery.
In Ontario it is a bit of both. Breast Reduction is covered by OHIP, however the OHIP (Ontario Health Insurance Plan) covers cutting out excess volume and repositioning the nipple. Plastic Surgeons often add liposuction to sculpt the breast to improve it’s appearance and to minimize scarring. This is done to enhance the ‘cosmesis’ of the breast and is not covered by OHIP. Large patients often have fatty tissue extending under the armpits. A typical breast reduction procedure does not involve the removal of this fat. If it were to be included, it would have to be cut out. Liposuctioning it out (which provides superior look by avoiding a large and long scar) is not an OHIP covered procedure.
Coverage by OHIP is not automatic. Every time a Plastic Surgeon plans to perform a breast reduction, he or she must submit an application for approval by OHIP. In that application the surgeon has to explain why OHIP should cover this procedure. If the surgeon can document that the patient’s large breasts (medically referred to as bilateral mammary hypertrophy or hyperplasia) are causing medical distress (not just a cosmetic distress), OHIP usually allows the surgery to go ahead. Typical medical issues patients may complain about are back pain, neck pain, shoulder grooving (from the pull of the bra), skin infection under the breast and skin breakdown because of problems with infection and moisture under the breast fold. Patient’s height, weight, and breast size are documented and should give an indication of how large the breasts are, and how likely they are to correspond with the patient’s problems.
Once the OHIP Approval for Surgery has been submitted, it usually takes 4-6 weeks to hear back from the Ministry. The response can be an approval to go ahead, a rejection, or a request for more detailed information about the patient before they make a decision. If an approval is obtained, the surgery can be scheduled. If an approval is not obtained, the patient has an option of proceeding with the surgery, however because the Ministry of Health has deemed it as a ‘Cosmetic’ issue, the surgical fee will then have to be paid by the patient. Fees for Breast Reduction without OHIP approval generally range from $4000-6000 + GST. This fee usually includes everything, including the sculpting Liposuction.
In other provinces and in the United States, coverage of Breast Reduction by insurance plans depends on various criteria. In some places it is considered a completely cosmetic procedure and it is not covered, while others have certain requirements for approval, such as a minimum amount of tissue that must be removed (to ensure that the procedure is a reduction, not just a lift) or that a patient must be a certain BMI (Body Mass Index) (to ensure that overweight patients first loose weight before seeking breast reduction).