Insurers pay for breast reduction (reduction mammaplasty) as a reconstructive procedure — not cosmetic — when large, heavy breasts cause documented physical symptoms. To prove it's "enough" tissue to be reconstructive, insurers use the Schnur Sliding Scale: a table that sets a minimum grams-per-breast based on your body surface area (BSA), which is calculated from your height and weight.
The logic is that breast size naturally tracks body size, so a fixed gram number would be too easy for a large-framed person and nearly impossible for a small one. The Schnur scale corrects for that: as your BSA goes up, the gram threshold goes up too. It's the reason two people can have the exact same surgery and only one of them is "enough" to be covered.
Here's the threshold at a few common body sizes. Cigna and Anthem use the standard Schnur 22nd-percentile scale; Aetna uses a notably stricter table that requires more tissue at the same body size:
| Approx. body size | Body surface area | Cigna / Anthem (per breast) | Aetna (per breast) |
|---|---|---|---|
| 5'4", 150 lb | ~1.75 m² | ~400 g | ~600 g |
| 5'7", 180 lb | ~1.95 m² | ~575 g | ~855 g |
| 5'10", 220 lb | ~2.20 m² | ~895 g | 1,000 g |
Notice the gap. At 5'7" and 180 lb, Cigna or Anthem would want roughly 575 grams per breast; Aetna wants about 855. That's the same patient, the same surgery — and a 280-gram difference in what counts as "enough," purely because of which insurer is reading the chart.
Hitting the gram threshold isn't sufficient on its own. Insurers also require documented physical symptoms from breast weight (neck, back, or shoulder pain; bra-strap grooving; rashes under the breasts) and, usually, a trial of conservative care first. Here's where they differ:
| Insurer | Qualifying symptoms | Symptom duration | Conservative care | Mammogram |
|---|---|---|---|---|
| Cigna | ≥ 1 | — | Medical management documented | — |
| Aetna | ≥ 2 | 12 months | 3 months | Required at 50+ |
| Anthem / Elevance | ≥ 1 | — | 3 months | — |
| UnitedHealthcare | Adjudicated via InterQual (reduction mammaplasty), not publicly published | — | ||
| Medicare | ≥ 1 | 6 months | 3 months | — |
| Medicaid | Varies by state — often stricter (more symptoms, mammogram at younger age) | |||
Aetna is the strictest across the board: two symptoms instead of one, a full 12 months of documented symptoms, a higher gram threshold, and a mammogram requirement at 50 and older. If you have Aetna, plan the documentation accordingly.
It's not necessarily over. The American Society of Plastic Surgeons' position is that medical necessity should be justified by symptoms, not resection weight — and many below-threshold cases are still approved when the symptom evidence is strong and well documented. Expect more pushback, lead with the symptom and functional documentation, and be ready to appeal. The gram threshold is a gate, not an absolute wall.
Enter your height, weight, and insurer, and see the Schnur threshold for your body size plus exactly what symptoms and documentation your plan requires.
Check my breast reduction coverageThere's no single number — it scales with your body size on the Schnur scale, from roughly 200–400 grams per breast at smaller body sizes up to about 1,000 grams at larger ones. Removing more than about 1,000 grams per breast qualifies regardless of size. The exact threshold for your body comes from your body surface area (height and weight), and Aetna's table requires more grams than Cigna's or Anthem's at the same size.
The Schnur Sliding Scale is a table insurers use to set the minimum grams of breast tissue that must be removed for a reduction to be considered medically necessary, based on your body surface area. It exists because breast size naturally tracks body size, so a fixed gram number would be unfair across different body types. As your body surface area rises, so does the gram threshold.
Because they determine your body surface area, which is what the Schnur scale uses to set your gram threshold. A taller, larger-framed person has to have more tissue removed than a shorter, smaller one to meet the same insurer's bar. Your surgeon records height and weight on the same date to support the calculation.
Often, yes, with strong documentation. Plastic-surgery guidelines hold that medical necessity should rest on symptoms rather than resection weight, and many below-threshold cases are approved when the neck, back, and shoulder symptoms and the failed conservative care are well documented. Expect more scrutiny and be prepared to appeal — the threshold is a gate, not an absolute cutoff.
Among the major insurers, Aetna is generally the strictest: it requires at least two qualifying symptoms (versus one for Cigna and Anthem), a full 12 months of documented symptoms, a higher gram threshold on its Schnur table, and a mammogram for patients 50 and older.
Usually some conservative care is expected — supportive garments, anti-inflammatory or pain medication, physical therapy, or weight management — documented before surgery. Aetna, Anthem, and Medicare generally want about three months; Cigna wants medical management documented. The point is to show the symptoms didn't respond to non-surgical measures.
That's exactly the basis insurers cover it on — when large, heavy breasts cause documented neck, back, or shoulder pain (plus often bra-strap grooving or skin rashes) that hasn't responded to conservative care, and enough tissue will be removed to meet your insurer's Schnur threshold. Pain alone, without the documented symptoms, gram threshold, and conservative-care trial, generally isn't enough.
Related: Cosmetic & reconstructive coverage checker · Is breast reduction covered by insurance? · Why prior authorizations get denied · all coverage tools