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Does OHIP Cover Breast Reduction Procedures?

If you’ve followed our blog in the past, you’re likely familiar with the fact that most cosmetic surgery procedures are not covered by OHIP, the Ontario Health Insurance Plan. However, there is one notable exception: breast reduction surgery.

So many patients are relieved to discover that breast reduction can be eligible for OHIP coverage. In a lot of cases, overly large breasts don’t simply look out of proportion with the rest of the body, leading patients to desire cosmetic changes alone. They also cause a lot of pain and constant discomfort in the back, neck, shoulders and breasts that can only be relieved with the help of a surgical procedure.

Having the extra financial support provided by this coverage often means patients face less of a financial burden and can choose to have this surgery sooner rather than later, ending aches and pains as early as possible. It can be a huge weight off your shoulders—literally.

Here’s what you need to know about OHIP coverage and breast reduction surgery.

Breast Reduction in a Nutshell

Also known by its formal name, reduction mammaplasty, breast reduction reduces the size and alters the shape of disproportionately large breasts. During the operation, excess fat, skin and glandular tissue are removed from the breasts, and the size of the areola (or darker tissue surrounding the nipple) can also be reduced. After the operation, breasts are smaller, lighter, and firmer, in better proportion with the rest of the body.

At The Plastic Surgery Clinic, our surgeons have pioneered a groundbreaking technique to minimize scarring on the breasts. Traditionally, breast reduction required three incisions in an anchor pattern: one around the nipple, one straight down from the nipple to the bra crease, and one along the bra crease (or “underboob”) itself. We use the “lollipop” or “stop sign” technique instead, eliminating the bra crease incision to minimize scarring.

The result is a totally natural-looking breast free from the burdens of neck and back pain, skin irritation, difficulty breathing or exercising, shoulder indentations from bra straps… as patients with very large breasts know, the list goes on and on. You can learn more about the results our surgeons have achieved by checking out our breast reduction before and after photo gallery.

Breast reduction patient before and after

Before and after breast reduction at our clinic. These images are presented for educational purposes only and should be interpreted subjectively. They do not represent the opinion or view of any patient regarding their result, and they are not intended to suggest the result that may be achieved by any other patient. The images are presented as factual guidelines and merely represent results that have been achieved by others. No two patients are alike and no two results are necessarily alike. Only a personal consultation with your surgeon can provide you with a reasonable expectation of the results you may achieve from any specific procedure.

The surgery typically takes about an hour. Patients need to plan to take one week off all regular activity where they’ll be able to stay at home in bed recovering. Very gentle exercising like walking can usually resume about two weeks after surgery. It will take a month before it’s okay to resume running or higher impact workouts. Your surgeon, recovery nurse and surgical coordinator will give you more precise instructions to follow carefully.

OHIP Coverage for Breast Reduction Surgery

It’s really important to note that not every breast reduction case automatically qualifies for OHIP coverage and there are a few considerations. However, there are a few predictors that can help indicate whether or not you qualify.

Indicators that your breast reduction may be covered by OHIP:

  • it has been deemed medically necessary, as opposed to strictly cosmetic
  • you experience significant associated symptoms
  • you experience frequent pain, including in the back, neck and shoulders
  • your posture is impacted by the weight of your breasts
  • your shoulders feel persistently indented from the pressure of your bra straps
  • you experience other symptoms like impediments to exercise, rashes and skin irritation
  • you are evaluated to have what’s known as “gross disproportion”

You do not require a referral from a doctor in order to have a free consultation with our surgeons about breast reduction. If you do happen to have one, that’s great too. However, it’s not a prerequisite to visit our clinic for this procedure. You’re welcome to have as many complimentary consults with our doctors as you need to help with your decision-making process.

During your free consultation, your surgeon will give you a comprehensive physical assessment. Based on what they see and what you discuss, they’ll be able to advise you at that time whether or not they feel you meet OHIP’s eligibility requirements.

The OHIP Approval Process

Once your surgeon has advised that you’re a good candidate for both breast reduction and OHIP eligibility, it’s actually quite straightforward and there’s nothing you need to do (aside from waiting, unfortunately). We will take care of submitting an application to the Ministry of Health of Ontario. It can take anywhere from about 6 to 8 weeks for the approval process to be completed. As soon as we hear back from OHIP, we will contact you right away and let you know their decision.

In the very rare case that your application is not approved, or if your surgeon determines that your particular procedure would not be eligible for OHIP coverage, we also have options for financing your breast reduction procedure if that’s something of interest to you.

Aspects of Breast Reduction Not Covered by OHIP

OHIP will approve only the reduction portion of your operation. This may sound a little confusing, since a breast reduction would seem to be strictly concerned with reduction itself. But often our surgeons incorporate an additional step in the procedure in order to achieve the most natural-looking result possible.

Most patients have a small roll of fat on the lateral chest (or side areas of the chest) and another roll at the front edge of the armpit. These pockets of fat will become more prominent and apparent when the breasts are smaller and lifted, creating a noticeably disproportionate look that is out of step with the overall result. In short, when this fatty tissue remains, it doesn’t look natural and is usually really out of line with the patient’s goals.

These areas need to be corrected with liposuction, which your surgeon performs at the same time. Because liposuction of fat for cosmetic reasons is not covered by OHIP, there is an additional fee for this. You will receive a firm quote for the cost of this aspect of your surgery after your first free consultation. If your surgeon determines this will be a necessary part of your operation—and to be clear, this is most frequently the case—it’s not optional and we won’t perform your breast reduction without it.

The decision to have surgery is a big one, and we know our patients don’t take it lightly. Cost is one of the many factors that go into making this choice. OHIP coverage for breast reduction is a great financial support for an operation that can improve not only the way your body feels, but the way you feel about yourself. While additional fees for liposuction may come as an unexpected surprise, they also amount to an investment in the best result possible and they eliminate the need for revision surgery to correct foreseeable unwanted outcomes.

Our patients have the highest rates of satisfaction when they get the look they want in one single operation. And with a 98% “worth it” rating on RealSelf, breast reduction rates as one of the most fulfilling and gratifying procedures we perform. If you have any questions about the information here, or if you’d like to learn more, don’t hesitate to come talk to us. We’d love to meet you, listen to your concerns and help in any way we can.

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