Understanding Medical Aid Coverage for  Breast Reduction Surgery

What Is Macromastia?

More than the struggle to find well-fitting clothing, the volume and weight of disproportionately large breasts cause a woman numerous physical problems that can have far-reaching psychological repercussions.

Macromastia, or breast hypertrophy, as it is clinically known, is a medical condition that may occur due to overdevelopment of glandular tissue during puberty or as deposited fat in the breasts as women age or become overweight. It can also occur as a result of hormone sensitivity and can affect just one or both breasts.

While there is no hard and fast rule as to what constitutes macromastia, a fair indication is that breast weight is approximately 3% or more of an individual's total body weight and breast tissue exceeds 1.5kg.

The sheer weight and size of abnormally-sized breasts can cause breast pain and severe physical disablement. Over and above these and other physical problems, the extreme burden of having to carry excessive weight makes normal day-to-day activities and exercise almost impossible. Emotional and social issues may arise, such as depression and lack of interaction with others.

Physical Symptoms of Breast Hypertrophy

The sheer weight and size of abnormally large breasts can cause significant pain and physical limitations:

• Muscular pain and discomfort – neck, shoulder, and back pain
• Numbness – pins and needles in the fingers, hands, or arms
• Posture – poor posture may compress nerve pathways
• Rash – redness, itchiness, and moisture under the breast can cause skin infections
• Breathing – the weight of the breasts can cause difficulty breathing

Reduction mammoplasty is performed by a plastic surgeon and involves removing breast tissue and excess skin, as well as repositioning the nipple. To alleviate pain, infection, and other complications, over-the-counter medication is often the first line of management.

Medical Aid Schemes Standpoint

Medical aids do not cover purely cosmetic procedures, but some may provide partial cover if the surgery is deemed medically necessary and the case meets the scheme’s ex gratia requirements.

They typically review medical motivation from specialists such as physical therapists, chiropractors, dermatologists, or orthopaedists. However, protocols differ across medical aids and product options.

Some, such as Discovery, may provide support for the conservative management of macromastia.

Momentum has also reviewed its breast reduction policy following the Juliet Harding case, acknowledging the need to improve benefit fairness.