Health insurance application for breast reduction

A specialist report for a health insurance application for breast reduction (mammoplasty) is a medical statement that serves as the basis for the health insurance company to decide on the coverage of the surgery costs. This report must detail the medical necessity for the breast reduction and explain that it is not for purely aesthetic reasons.

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Content of the specialist report

This type of report is usually prepared by a specialist in Plastic and Aesthetic Surgery, an orthopaedist, or a gynecologist. It includes the following key points:

Patient data

• Name, date of birth, insurance number
• Current height and weight (BMI calculation)
• Cup size before the planned surgery
• Medical indication (justification for the surgery)
• Chronic pain: Persistent pain in the back, shoulders, and neck associated with excessive breast size.
• Skin problems: Inflammation or eczema in the inframammary fold due to constant friction and moisture.
• Restrictions in daily life: Limited movement, difficulty with physical activities or professional tasks.
• Orthopaedic problems: Poor posture, posture damage, or degenerative spinal changes that do not improve with conservative treatments (physiotherapy, pain therapy).
• Psychological stress: If applicable, psychological distress (e.g., depression, self-esteem issues) caused by large breasts can be documented.

Previous treatments and their effects

• Evidence of conservative therapies such as physiotherapy, pain therapy, weight reduction, or special bra support.
• If these measures were unsuccessful, this should be mentioned in the report.

Description of the planned surgery

• Details of the planned amount of tissue removal (often health insurance companies require a minimum of 500g per breast, but this is not uniformly regulated).
• Surgical technique (e.g., T-scar, L-scar, or I-scar).
• Expected functional and health benefits

What happens after the health insurance application?

• You will receive the specialist report and send it to the health insurance company.
• If your application is approved, you may undergo surgery at a publicly funded clinic of your choice.
• If the application is rejected, you can appeal, or have the surgery performed by a doctor of your choice as a self-paying procedure.