I frequently see patients in consultation for breast reduction surgery. Even though most patients have decided that they want to proceed with breast reduction surgery before they even meet with me, nearly all of them want to know if their operation is medically necessary. Further, and maybe even more importantly, my patients want to know if their insurance company will approve their surgery as medically necessary. These are not one and the same. My insurance authorization team works tirelessly to get medically necessary operations approved (i.e.pre-authorized) prior to surgery; we have a very good track record doing so. The reason we are so successful is that we know what procedures are medically necessary and frequently we know what criteria the reviewers require. Further, we do not waste time attempting to get unjustified surgical procedures approved.
When it comes to breast reduction surgery it takes good surgical judgment and a fair amount of experience in order to know ahead of time, the correct tissue amount that will need to be reduced from a hypertrophic breast. Further, as a plastic surgeon, I must also determine ahead of time the amount that I believe that a patient’s insurance company will require that I remove in order for it to be considered a medically necessary procedure. One tool that is useful in determining the “minimum required amount” of breast tissue that should be removed is the Schnur Sliding Scale.
The Schnur Sliding Scale chart is an evaluation method used with individuals who are considering breast reduction. This method was developed by a plastic surgeon who was studying women who had breast reduction surgery for medical reasons.The patients body surface area and average weight of breast tissue removed is incorporated into this chart. If the patient’s body surface area and weight of breast tissue removed fall below the 22nd percentile, then the surgery is deemed cosmetic in nature, and therefore not medically necessary. If however, these two factors are above the 22nd percentile, then the operation is considered medically necessary when the appropriate criteria are met.
*photos on this post are of an actual pre-operative patient of Dr. Brenner.
Not sure what your body surface area is (BSA); calculate it here.
|Average grams of tissue per breast to be removed|