Breast Reduction, the Schnur Scale, and Insurance Coverage. What is the Schnur Scale? Three Things You Need to Know.

I love to do breast reductions.

When your breasts are large and droopy, it profoundly affects how you feel, your ability to exercise, what clothing you wear.  When I started my practice, most of the breast reductions I did were covered by insurance. It was simple: a woman who had large droopy breasts came in; I agreed her breasts were large and droopy; we submitted it to insurance with photos; and usually it was covered with a removal of 300g of tissue.

Then the Schnur scale came out, I adopted the short scar vertical breast reduction, and things changed a bit. Now it is tougher to get insurance coverage.

1. Insurance companies vary on their criteria for breast reduction coverage. There are rare plans which do not cover breast reductions at all, but most still do.  What they want is for you to prove it is “medically necessary.”  To show this, they require a certain WEIGHT of tissue be removed.

Weight does not equal volume.  Imagine two women with 34 DDD breasts who want a 34C/D cup.  How much do I need to remove?  Well, it varies.  When you do a reduction, you compact the tissue which is there. Some people will go down a cup size or two just from the compression (imagine how you look smaller in a minimizer bra or jog bra.  No surgery, just compression.)

Your breast is like a pillow. Some people have dense pillows which don’t compact well and weigh a lot.  Others have a light pillow which can smash down into a small package. Insurance companies are focused just on the weight, not the cup size.

I have had some patients where the amount “required” by insurance for me to remove would be equivalent to removing the entire breast. We can’t safely do that, so insurance will not cover.

2.The Schnur scale came out of a study done by plastic surgeons to prove the medical improvement in posture, neck and back pain from doing breast reductions. A side effect was it correlated this improvement with body surface area, and so for many patients the weight needed to be removed increased.

Body surface area correlates to BMI.  What they are saying is if you are overweight, your breasts are big because you are overweight.  They require more volume taken out because of this.  If you want to find out what your Body Surface Area is, there is a link to a body surface area calculator.

I have VECTRA 3D imaging in my office. It helps estimate what the volume of your breast is.  I also have sizing implants which show what 300cc or 500cc looks and feels like, to help you visualize your change.

3.  I “cut out” less than I used to because of my shorter scar technique.  In my short scar vertical breast reduction I liposuction the tissue which runs into the axilla and bra line. In the Wise anchor pattern breast reduction I would cut out this tissue, so even though it is fat, it would be included in the weight total. Now it is liposuctioned, and many insurance companies will not let include it in the weight total.

When you come into my office, I will review all of this with you.  There are other factors which can show medical necessity, but many companies have refused patients of mine who had objective changes in neck Xrays, jaw pain, and other issues, because they said we must hit the Schnur scale number.

The Schnur scale is listed below. For reference, 500g is a little over one pound of tissue.