What Is The Criteria For A Breast Reduction To Be Medically Necessary?



What Is The Criteria For A Breast Reduction To Be Medically Necessary?

If you are plagued with large breasts that are causing major problems, breast reduction surgery can prove very beneficial to your well-being. There are many factors involved for a reduction to be medically necessary, and you will need to meet with a breast reduction surgeon for a consultation to determine your eligibility.

Breast Reduction

Why is breast reduction done?

Breast reduction is a cosmetic surgery that changes the size, weight and shape of the breasts by removing excess tissue and fat deposits. For many women, having big breasts is a burden because they cause back and neck pain, posture issues and skin irritation. Furthermore, the pull of bra straps on the shoulders can create indentations. Large breasts can also limit the physical activities you can do because you cannot find a sports bra or exercise clothes made to support your ample chest. In some cases, even with the right support garments you may find physical activities painful due to your chest size. Finally, large breasts can cause unwanted attention and appear disproportionate in relation to your weight and height.

What criteria is needed for your breast reduction to be medically necessary?

In Canada, most medical breast reductions are covered, but the government has certain criteria in place that a woman must meet in order for her reduction to be deemed a medical necessity:

  • Back, neck and shoulder pain
  • Bad posture caused by the weight of the breasts
  • Rashes under the breasts in the area where the bra meets skin
  • Indentations/grooves in the shoulders from the bra strap
  • Inability to do any physical activities comfortably

Finding a breast reduction surgeon

Your primary care physician will refer you to a surgeon they trust. You can also find a reputable breast reduction surgeon online. If you are going to find the surgeon yourself, ensure that the one you choose is board certified and has experience with the procedure. You can ask the following questions to see if a breast reduction surgeon is right for you:

  1. How many years have you been practising?
  2. Where did you go to medical school?
  3. How many breast reductions have you performed?

Once you find a qualified breast reduction surgeon, they will submit paperwork on your behalf to the Ministry of Health, who will determine if your surgery will be covered by OHIP (or whatever provincial health plan is in place where you live) . The approval from the ministry can take anywhere from one week to three months.

Some provinces have a minimum gram removal requirement for breast reductions. However, it’s safe to assume that if you meet the criteria for a medical breast reduction that you will meet the gram removal minimum as well.

Please contact us for more information.

October 23, 2017

Leave A Comment


  • User - Mclean Clinic

    Posted on Oct 23 2017 By Brittany

    I am wondering whether or not I need a referral from a GP before seeking a consultation if the procedure is to potentially be covered by OHIP?

  • User - Mclean Clinic

    Posted on Oct 23 2017 By McLean Clinic

    Hello Brittany – you do not require a GP referral before seeking a consultation with us.

    Please feel free to contact us at
    866-731-0431 and we’ll be happy to discuss options with you.

    Thank you.

  • User - Mclean Clinic

    Posted on Oct 23 2017 By McLean Clinic

    Hi Brittany – you do not need a GP referral for a Breast Reduction.

    Please feel free to call us at 866-731-0431, and we will be sure to review best options with you.

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