Insurance Breast Reduction NYC

Find out if your breast reduction is covered — free, and usually the same day. Fill out the short form below and our insurance team will check your benefits and tell you exactly what your plan covers before you commit to anything. There’s no cost and no obligation.

Breast reduction (reduction mammaplasty) is a procedure that can be covered by insurance when deemed medically necessary. It decreases the size of the breasts and repositions them to improve comfort and balance proportions. Large breasts can cause excessive strain, resulting in back, neck, and shoulder pain. Reducing breast size helps patients find relief from back, neck, and shoulder pain, improve mobility, expand clothing options, eliminate the need for specialty bras, treat rashes and moisture issues under the breasts, lessen migraine headaches, reduce negative attention toward your chest, improve the symmetry of your breasts, and boost your self-esteem. Each year, plastic surgeons perform breast reduction more than 76,000 times to help patients enhance the appearance of their breasts. ⁽¹⁾

Dr. Marc Everett is a premier breast reduction specialist in NYC and performs breast reduction surgery several times weekly, more than nearly any other board-certified plastic surgeon in the region. At ME Plastic Surgery, we take care of a wide range of patients coming to the office with a wide range of complaints from the teenage years through the retirement years of life. Meet with Dr. Everett to determine if you are a candidate for him to help you achieve life-changing results, improving your mobility and body proportions, and empowering you to make a change for an overall enhanced quality of life.

Contact our offices in Manhattan or Queens or call (212) 774-7715 to learn more and schedule your consultation today!

Breast reduction can change the entire way you live. Let’s debunk the myths that stoke fear.

About Breast Reduction Covered by Insurance

Whether you developed heavy, oversized breasts at puberty or if you recently experienced changes to your breasts after pregnancy-related changes, breastfeeding, or fluctuations in your weight, breast reduction can rebalance your proportions to help you feel more comfortable and confident. During the procedure, Dr. Everett will reshape the breasts to create a smaller breast mound, removing both fat and glandular tissue for natural-looking results. If you are struggling with back pain, neck pain, or skin irritation from large breasts, the procedure can help you address these concerns.

Whether you experienced changes to your breasts after weight fluctuations, breastfeeding, or pregnancy, breast reduction can help improve your comfort in your daily life. During the procedure, Dr. Everett will reposition the nipple and/or reduce its size during surgery to achieve a natural, harmonious appearance.

Breast Reduction After Weight Loss

After weight loss, it is common for the breasts to sag and remain overly large, a condition colloquially known as “Ozempic breast.” If you are looking to improve the appearance of your breasts after weight loss, Dr. Everett can remove the excess tissue for a smoother, curvier figure. Depending on your aesthetic goals, he can combine breast reduction after weight loss with other post-weight loss body contouring procedures.

Benefits of Breast Reduction

After a medically necessary breast reduction, you can enjoy:

Improved posture: You can find relief from back, neck, and shoulder pain after the procedure, which can improve your posture.
More clothing options: Many patients feel more comfortable in different types of clothing with a more proportional figure.
Improved breast symmetry: Dr. Everett can reshape the breast mounds to balance the breasts and address asymmetry.
Improved self-confidence: You can enjoy feeling better about your figure with a curvier, more proportional appearance.
Enhanced mobility: With smaller breasts, you can enjoy improved mobility, making exercise easier.

Candidates for Breast Reduction Insurance Coverage

Candidates for breast reduction insurance coverage are those who need to undergo the procedure to improve their quality of life.

Although there is no age limit for the procedure, you will need to have fully developed breasts for the procedure. If you are pregnant or breastfeeding, you will need to wait until a few months after you finish breastfeeding.

How to Qualify for Insurance-Covered Breast Reduction in New York

Insurers in New York generally look at the same handful of things when they decide whether breast reduction is medically necessary rather than cosmetic. You may be a candidate for insurance-covered breast reduction when:

You have documented symptoms — back, neck, or shoulder pain; skin irritation or rashes under the breast crease; grooving from bra straps; or trouble exercising — that have lasted several months or longer.
You’ve already tried conservative treatment, such as physical therapy, over-the-counter pain relief, or supportive bras, and your records show it didn’t give lasting relief.
Your surgeon’s estimate of how much tissue will be removed, relative to your height and weight, meets your plan’s medical-necessity threshold; insurers vary on where they set this bar.
Your breasts are fully developed, and if you’re pregnant or breastfeeding, you’ve waited until a few months after you stop breastfeeding, since size and shape keep changing during that time.
Your plan is one we work with (see below) and your surgeon submits photos and medical history for prior authorization.

Meeting these criteria supports your case, but your insurer makes the final coverage decision — we can’t promise approval before your plan reviews the request.

Consultation

During your consultation, Dr. Everett will ask about your aesthetic goals and examine your breasts to determine the best treatment plan for your needs. He will also ask about your lifestyle, current medications, and medical history.

Please come prepared with any questions about the procedure to help him create a personalized plan. He can perform several different types of body contouring procedures to sculpt your figure and help you achieve your aesthetic goals.

To learn more, see the blog!

Preparation

To prepare for breast reduction, you will need to follow all of Dr. Everett’s recommendations. This includes stopping to take oral birth control medications and many weight loss medications. You must stop using all nicotine products at least a month before and a month after surgery. Ahead of surgery, Dr. Everett will make sure you have all of the required post-operative support garments and all of your home medications before your day of surgery. Depending on what you do for work or school, he will help you determine how long you should set aside for your recovery.

Procedure

The operation is performed under general anesthesia, which means you will be completely asleep throughout the operation.

In general, Dr. Everett believes that breast reduction surgery should be performed through an anchor-shaped incision (inverted T): This incision goes around the areola and extends vertically down to the inframammary crease, then continues horizontally along the crease. Fortunately, this incision pattern has the least tension on it and tends to heal beautifully, with most scars difficult to even see in 1 year’s time. For patients who are candidates for an internal bra procedure, Dr. Everett will use an absorbable mesh to support the shape and position of the breast in the early healing phases. Dr. Everett will also perform a procedure that helps to block your sensation of pain in the breasts after surgery, and because of this, most patients do not require heavy pain medication during their recovery. After surgery, you will be monitored in the recovery room, and you can return home to rest afterward. All of these operations are same-day surgery. Dr. Everett will send you home with specific instructions to help you recover.

Results

Your results will depend on your aesthetic goals, as discussed during your consultation. After breast reduction surgery, you can enjoy a smaller breast mound, balanced body proportions, and less discomfort associated with overly large breasts.

Many patients find that the procedure improves their mobility and self-esteem because they can exercise more easily and their clothing fits better. Many patients also notice fewer rashes. Results are long-lasting and can be maintained if patients exercise consistently and eat healthily to maintain a stable weight.

Insurance Coverage Process

After your breast reduction is deemed medically necessary, your coverage will depend on the type of insurance you have. Dr. Everett’s office will obtain To obtain coverage, your insurance may require prior authorization– using documentation about your medical history, photographs, and findings from your initial consultation that prove the procedure is medically necessary. After your consultation, we can provide the necessary documentation. You will also need to consider your:

Deductible: The cost of your procedure will depend on whether or not your insurance has a deductible. If you have not met your deductible for the year, your insurance will adjust the cost of your procedure accordingly.
Co-insurance: Depending on the type of plan you signed up for, your insurance may have co-insurance. This means that the insurance company will pay a percentage of the cost of healthcare services after you meet your deductible (if your plan has a deductible).
Out-of-Pocket Maximum: Your out-of-pocket maximum is the maximum amount you will pay for healthcare services for the year before your insurance company covers the full cost of services.

Insurance Plans We Work With for Breast Reduction

Our office verifies breast reduction benefits directly with:

Aetna
Cigna
EmblemHealth GHB/CBP
EmblemHealth NYC
Meritain
Oxford
UnitedHealthcare
Other major carriers — ask us to check your specific plan

We do not currently accept Medicare, Medicaid-managed plans (including UnitedHealthcare Community Plan or Blue Cross plans starting with JLJ), Fidelis, HealthFirst, Tri-Care, Amida Care, Oscar, or MetroPlus plans.

Being with a carrier on this list doesn’t guarantee coverage — your specific plan and whether your case meets its medical-necessity criteria still decide the outcome.

How Our Insurance Verification Works

You request a free insurance check — no cost and no obligation.
Our team reviews your plan, often the same day, and tells you what your insurer requires.
If your symptoms and history support medical necessity, we submit the prior-authorization request with your photos and records, and we follow up with your insurer on your behalf.
We let you know the outcome and, if approved, help you schedule a consultation.

The Cost of Breast Reduction Covered by Insurance in NYC

The cost of your breast reduction will depend on the details of your case. After your insurance company processes the claim for your procedure and deems it medically necessary, we can proceed with a breast reduction that will be covered by insurance. Most patients with qualified insurance plans have low or no out-of-pocket costs.

Contact our offices in Manhattan or Queens or call (212) 774-7715 to schedule a consultation and learn more about the procedure!

FAQ

Do you accept all kinds of insurance?

We work with a great many of the insurance carriers. We do not accept Medicare, Medicaid-managed plans (including United Healthcare Community Plans or Blue Cross plans starting with JLJ), Fidelis, HealthFirst, Tri-Care, Amida Care, Oscar, or MetroPlus plans. If you’re unsure, contact us, and our insurance verification team will check your benefits and get right back to you!

Will my breast reduction be covered by insurance?

For your breast reduction to be covered by insurance, it must be deemed medically necessary. If you suffer from back and neck pain because of overly large breasts, your breast reduction will likely be covered by insurance.

Can I combine breast reduction surgery with other procedures?

Absolutely. If you have recently lost weight, we can perform additional procedures to refine your silhouette and assist in shaping your body for a slimmer, more athletic appearance.

How long will the results of breast reduction surgery last?

During breast reduction, we permanently remove the breast gland and excess skin, so the results can last for years and for some, the rest of their lives. However, pregnancy-related changes after breast reduction surgery can change the appearance of your breasts.

Is breast reduction covered by insurance in NYC?

It may be, when your symptoms and documentation meet your plan’s medical-necessity criteria. We verify your specific plan for free before you schedule anything.

Is insurance-covered breast reduction available in Manhattan?

Yes — Dr. Everett and Dr. Zhao see patients for insurance-covered breast reduction at our Manhattan office, 936 5th Ave, and our Rego Park, Queens office. Coverage still depends on your individual plan.

Which plastic surgeons in Manhattan accept insurance for breast reduction?

Dr. Marc Everett (board-certified, ABPS) and Dr. Ruya Zhao at ME Plastic Surgery accept and verify several major carriers for breast reduction (see the list above) and handle the prior-authorization paperwork in-house.

How do I qualify for insurance-covered breast reduction in New York?

See “How to Qualify” above — documented symptoms, a record of conservative treatment that hasn’t worked, and a tissue-removal estimate that meets your plan’s threshold are the usual factors.

Is breast reduction surgery covered by UnitedHealthcare in New York?

Commercial UnitedHealthcare plans are among the carriers we verify for breast reduction. UnitedHealthcare Community Plan (Medicaid-managed) is not accepted. We confirm your specific plan’s terms as part of free verification.

Does insurance cover breast reduction surgery in New York?

It can, when the procedure is medically necessary rather than cosmetic and your documentation supports that. Every plan sets its own criteria, which is why we verify before you commit to a date.

How do I get a breast reduction covered by insurance?

Request free verification, gather records of your symptoms and any conservative treatment you’ve tried, and let our team submit the prior-authorization request and follow up with your insurer.

References

American Society of Plastic Surgeons ® Endorsed Partner. https://www.plasticsurgery.org/documents/news/statistics/2023/plastic-surgery-statistics-report-2023.pdf

Free Insurance Verification