Breast Reduction and Lower Abdominal Skin Removal May be Covered by Medical Insurance after Bariatric Surgery
March 9, 2022: Dr. Volshteyn will be our guest speaker during our bi-monthly Bariatric Support Group meeting.
Some post-bariatric surgery patients who have lost a substantial volume of weight will experience excess skin in the mid-section of the body or sagging breasts. Typically, surgical enhancement of these areas via plastic surgery is not covered by private medical insurance.
However, New Jersey board-certified bariatric surgeon Dr. Seun Sowemimo of Prime Surgicare, and board-certified plastic surgeon Dr. Boris Volshteyn of Atlantic Surgical Associates PA, identified two plastic surgery procedures often covered by medical insurance plans: female breast reduction and panniculectomy (lower abdominal excess skin removal).
“These two operations can help people with significant weight loss to achieve a more streamlined physique with minimal downtime,” notes Dr. Volshteyn. “The breast reduction can also help women reduce chronic neck and back pain.”
Beginning in February 2022, the two surgeons will launch a collaboration to help Prime Surgicare’s Bariatric Success patients continue to improve their physical appearance after surgical weight loss, focusing on these two procedures.
“The physical remnants of weight loss should not hinder people who have dramatically improved their health with bariatric surgery,” says Dr. Sowemimo. “Removing excess skin and lifting the breast tissue can make a marked improvement in the patient’s physical and emotional well-being.”
The criteria to secure insurance coverage for these procedures are stringent.
We have outlined the general qualification parameters, the scope of each procedure and pre-certification requirements:
What are the patient benefits of these two surgeries?
After successful weight loss, these surgical enhancements will reveal a more youthful and healthy appearance, increasing self-confidence to fully participate in all aspects of life without concern about the remnants of the former body.
The removal of excess lower belly skin will immediately slim the waist and hip area. Clothing will fit more smoothly and the mid-section will appear more streamlined. The breast reduction operation will lift the breasts, creating a more youthful bustline, and helping to reduce or eliminate chronic back and neck pain from heavy breast tissue.
What operations may be covered by medical insurance?
With qualifying physical symptoms, breast reduction and panniculectomy (lower abdominal excess skin covering the genitals) can be covered corrective procedures for patients with private medical insurance.
How long after WLS is this surgery advisable?
These procedures are recommended at least 12 to 18 months after weight loss surgery when weight is stable.
What are the general criteria to qualify for this type of surgery?
- Your weight is at or near goal weight (the majority of necessary weight loss has been achieved)
- You are in stable overall health.
- You don’t smoke.
- You are committed to proper nutrition, fitness, and an overall healthy lifestyle
- You are between ages 20 and 65.
Who will perform my operation?
Drs. Volshteyn and Dr. Sowemimo will partner to perform your operation. You will have pre-op consultations with both doctors and post-op follow-up appointments with Dr. Volshteyn.
Where will my surgery be performed?
Your operation will be performed at CentraState Medical Center in Freehold or Old Bridge Medical Center (formerly Raritan Bay Medical Center) in Old Bridge.
What are the criteria to obtain coverage for breast reduction?
Patients should review their medical insurance plans to determine the specific requirements to be approved for covered surgery. Typically, these criteria can include:
- Consult with a primary care doctor to document back pain and neck pain.
- Current breast size should be at least 500 gms per side.
- Documented complaints of neck pain, back pain or shoulder pain
- Use of nonsteroidal anti-inflammatory medical for six months
- Some medical plans require physical therapy or chiropractic care visits documenting no marked improvement in pain.
Is breast reduction a day surgery procedure?
Yes, it is generally a same-day procedure with minimal post-op pain. Patients may perform light computer-type activities a few days after surgery.
What are the criteria to obtain coverage for panniculectomy (lower abdominal surgery)?
Due to significant weight loss and gravity, lower abdominal fat can pull the abdominal skin down, creating a pannus. It may look like a ‘fat roll,’ but it is actually just excess skin. It can create an apron or hammock-looking distribution of skin and fat in the lower abdomen, extending from hip to hip.
To qualify, the pannus typically needs to hang below the genital area with patient complaints of difficulty maintaining successful hygiene or preventing normal mobility.
Keep in mind, an abdominoplasty (tummy tuck), which involves elevation of the excess skin flap, is considered cosmetic and is not covered by medical insurance. However, the patient can choose to pay for this additional procedure, which can be performed during the panniculectomy.
Pain after a panniculectomy is minimal, but can be more significant if the lower abdominal muscle is tightened.
This operation can be a covered procedure for men and women and generally requires an overnight hospital stay.
Can the breast reduction and panniculectomy be performed in the same surgery?
Yes. Undergoing both procedures will require a minimum one-night hospital stay.
Are you interested in bariatric post-op panniculectomy or breast reduction?
If you have been near or at goal weight for a minimum of six months, you can start the process immediately:
- Call Prime Surgicare at 732-414-2707 to schedule a consultation with Dr. Sowemimo.
- After your consultation with Dr. Sowemimo, call Atlantic Surgical Associates PA at 732-641-3350 to schedule an appointment/exam with Dr. Volshteyn.
- Following these two visits, insurance coverage will be confirmed and you will begin pre-op testing after your date of surgery is scheduled.
- Dr. Volshteyn will oversee your pre- and post-op plastic surgery care.
About Dr. Seun Sowemimo | Prime Surgicare
Dr. Seun Sowemimo, medical director of Bariatric Surgery at CentraState Medical Center, is a board-certified bariatric, laparoscopic and general surgeon. Dr. Sowemimo completed his general surgery internship and residency training at the College of Physicians and Surgeons, Columbia University, Harlem Hospital Center, New York City. After completing clinical clerkships at Kings College Hospital, London, Dr. Seun completed surgical fellowship training in advanced minimally invasive (laparoscopic), robotic and open bariatric surgery at Yale University School of Medicine, Hospital of St. Raphael. He has appeared on Dr. Oz, CBS, NY1 and News 12. His private practice, Prime Surgicare, has offices in Freehold and Jackson, NJ. Dr. Sowemimo can be reached by calling 732-414-2707.
About Dr. Boris Volshteyn | Atlantic Surgical Associates PA
Dr. Boris Volshteyn, chief of Plastic Surgery at CentraState Medical Center in Freehold, is a board-certified plastic surgeon. He received his medical degree from the University of Missouri-Columbia, graduating magna cum laude. His surgical training in general and plastic surgery was completed at the University of Missouri. He also completed clinical research and fellowship in microsurgery and cosmetic surgery at the Manhattan Eye, Ear, and Throat Hospital (MEETH) in New York City. In addition, Dr. Volshteyn completed advanced training in mesotherapy in Paris under renowned Dr. Jacquesce Coz and cell therapy in Lausanne, Switzerland. His private practice, Atlantic Surgical Associates PA, is located in West Long Branch, NJ. Dr. Volshteyn can be reached by calling 732-641-3350.