Benefits

Breast reduction – when is it covered by health insurance?

INFORMATION
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Large breasts can lead to severe back pain. Source: iStock / elenaleonova

A large bust can be a heavy burden – not just psychologically and physically, but financially as well. Comparis explains in what cases your health insurance will cover some of the costs.

Breast reduction surgery is not necessarily a cosmetic procedure. Many operations are medically necessary, as women with oversized bosoms suffer pain and discomfort.

Adverse effects of large breasts

Large breasts are often associated with physical problems. Those affected often have neck and back pain, which keeps recurring or leads to permanent posture problems, despite therapy. In extreme cases, the breasts may weigh two kilos per side – placing considerable strain on the spine. Other common symptoms include eczema under the overhanging breasts and bra straps that cut painfully into the skin. Then there is the psychological strain, which is a problem for many.

Breast reduction provides relief

With a breast reduction – also known as a reduction mammaplasty – affected women can be relieved from their burden. During this operation, excess skin, glandular tissue and fat are removed, thereby reducing the volume of the breast. The nipple is returned to its original position. 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 is important that the woman has stopped growing and the bust is fully developed. You can find out more about the operation here.

Health insurance cover not always available

This kind of operation is expensive – often costing over 10,000 francs. Health insurers will pay some of these costs in certain cases, as very large breasts can cause health problems. Essentially, in order for breast reduction to be classified as a statutory benefit under basic health insurance, the following criteria must be fulfilled:

  • The large breasts cause regular physical or psychological symptoms of clinical significance.
  • There is a causal relationship between these symptoms and the large bust.
  • Surgery would lead to the elimination of these complaints.
  • A minimum of 500 grams of tissue is removed from each side.
  • The Body Mass Index (BMI) is no greater than 25 kg/m².
  • Conservative measures (e.g. medication, physiotherapy and back exercises) have had no effect.

If you do not meet these criteria, then breast reduction is considered a cosmetic procedure. As a last resort, a supplemental insurance policy may cover the costs – but just a proportion of them. Some health insurers offer supplemental insurance policies that cover cosmetic procedures. This kind of policy usually also covers some of the costs of a breast enlargement.

In any case, you are advised to consult a surgeon and ask your health insurance company whether and to what extent it covers the cost of a breast reduction. Always ask your insurer for confirmation that payment of the costs is approved. In the event of a dispute, contact the ombudsman service for health insurers (link in German, French and Italian only).

Note: if you make an advance payment to the doctor before obtaining the approval of your health insurer, you are obliged to accept the price.

Still have questions or want to offer advice from your own experience? Discuss this issue with other affected women in our forum.