Breast reduction and health insurance: what’s covered?
A large bust size can be a burden – mentally, physically and financially. Comparis explains the costs of a breast reduction and what health insurance covers.
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1. The most common reasons for a breast reduction
Breast reduction isn’t always a form of cosmetic surgery. Many breast reductions are medically necessary, as oversized breasts can trigger various ailments. Here are some of the most common reasons why women may choose this procedure:
Medical complaints: oversized breasts can lead to chronic back and neck pain, as well as harm to posture. Despite therapy, these issues can recur or lead to permanent posture problems.
Skin problems: large breasts can cause skin irritation and inflammation in the inframammary fold.
Restricted freedom of movement: many women feel restricted by their large breasts during sports activities and everyday movements.
Psychological burden: large breasts can impair self-confidence and cause psychological stress.
Aesthetic reasons: many women want a breast reduction to bring the proportions of their breasts more in line with the rest of their body. In this case, breast reduction is considered cosmetic surgery.
2. Breast reduction provides relief
Breast reduction helps relieve complaints. Breast reduction surgery is also known as reduction mammaplasty. During an operation, excess skin, mammary gland and fat tissue is removed. This reduces the size of the breast.
The nipple is returned to its original position to ensure a natural appearance. With the remaining tissue, the breast is reshaped and the skin encloses it more tautly.
In theory, breast reductions can be performed on women of any age. However, it’s important that the woman has stopped growing and the bust is fully developed.
3. Breast reduction: costs in Switzerland
The cost of a breast reduction in Switzerland varies from one clinic to another and depending on the scope of the procedure. It typically costs between 10,000–15,000 francs. These costs include both the costs of surgery and anaesthesia, hospitalization and follow-up examinations.
In any case, you are advised to consult a surgeon and ask your health insurer whether and to what extent it covers the cost of a breast reduction. You should request a commitment to provide cover in good time. Otherwise, you may bear the cost of the treatment yourself.
4. When does health insurance pay for a breast reduction?
In Switzerland, basic health insurance covers the costs of a breast reduction if the procedure is necessary for medical reasons. Usually, the health insurer requires a medical opinion confirming the medical necessity of the operation.
Essentially, in order for health insurance to pay, the following criteria must be fulfilled:
The large bust causes regular physical or psychological symptoms. The symptoms must be demonstrably clinically significant.
A minimum of 500 grams of tissue is removed from each side.
The body mass index (BMI) is greater than 25kg/m².
Conservative measures (such as medication, physiotherapy and back exercises) have not helped.
Do you meet all of these criteria? Then you have a good chance of receiving a commitment to provide cover from the health insurer.
If you don’t meet these criteria, a breast reduction will be considered a cosmetic procedure. In this case, the health insurer will not cover the costs of the operation. However, supplemental insurance may cover some of the treatment costs.
To apply for a breast reduction with the health insurer, you first have to see a doctor. The doctor will examine the medical necessity of a breast reduction and prepare a medical report. This documents your symptoms and previous treatments. You can then submit this report to your health insurer.
5. Supplemental insurance for a breast reduction
Some health insurers offer supplemental insurance policies to cover cosmetic procedures. These are often outpatient supplemental insurance policies or combined products. This supplemental insurance usually covers a portion of the cost of a breast reduction.
6. Breast reduction for men: when does health insurance pay?
A breast reduction for men is called gynecomastia. In Switzerland, it is only covered by health insurance under certain conditions.
The decisive factor is whether the cause of the enlarged breast is an excessive proliferation of glandular tissue. If this is the case, a breast reduction is considered medically necessary. The costs will be covered by health insurance after a prior commitment to provide cover.
If the enlarged breast is caused by too many fat deposits, breast reduction is considered a cosmetic procedure. In this case, the health insurer will not cover the costs.
This article was first published on 08.12.2021
