Breast Reduction and OHIP: What’s Covered
in Ontario

OHIP classifies breast reduction as medically necessary when the size of the breasts is causing documented physical symptoms. These typically include:

Chronic back pain. Persistent lower, mid, or upper back pain that is attributed to the weight and forward pull of large breasts.

Chronic neck pain. Ongoing neck strain and stiffness.

Shoulder grooving. Deep, permanent indentations in the shoulders from bra straps bearing excessive weight.

Skin irritation and infection. Rashes, fungal infections, or chronic skin breakdown in the inframammary fold (the crease beneath the breast).

Postural problems. Kyphosis or other postural changes resulting from compensating for breast weight.

Physical activity limitation. Inability to exercise comfortably or participate in normal activities due to breast size.

Nerve symptoms. Numbness or tingling in the hands or arms related to postural strain.

The key requirement is documentation. Your family physician must document these symptoms in your medical record before making a referral to a plastic surgeon.

To be assessed for OHIP-covered breast reduction, you need a referral from your family physician to a plastic surgeon. Here is the typical process:

Step 1: Discuss your symptoms with your family physician. They will document your physical complaints, any treatments you have tried (physiotherapy, supportive bras, pain medication), and the impact on your quality of life.

Step 2: Your physician provides a referral to a plastic surgeon — such as Dr. Huq at NPSC.

Step 3: Dr. Huq performs a consultation to assess your anatomy, confirm medical necessity, and discuss the surgical plan.

Step 4: If the criteria are met, Dr. Huq submits the necessary documentation to OHIP for pre-approval.

Step 5: Once approved, surgery is scheduled.

Covered by OHIP

When approved, OHIP covers the surgical component of breast reduction — the surgeon’s fee and the hospital or facility fee for the medically necessary portion of the procedure.

Not Covered by OHIP

Certain components of breast reduction are classified as cosmetic and are not covered, even when the overall procedure is OHIP-approved:

Liposuction component. When liposuction is used for contouring the breast or surrounding areas (axillary fat, lateral chest), this is considered a cosmetic addition. At NPSC, the liposuction component is $4,000–$5,000 out of pocket.

Cosmetic refinements. Any additional procedures performed for purely cosmetic reasons (such as a concurrent breast lift beyond what is necessary for the reduction) may not be covered.

Facility upgrades. If you choose to have the procedure in NPSC’s private accredited facility rather than a hospital, there may be a facility fee difference.

Dr. Huq has extensive experience with breast reduction — both OHIP-covered and cosmetic cases. During your consultation, he will:

• Assess your breast size, shape, and the degree of reduction needed
• Evaluate your symptoms and their documentation
• Discuss the surgical technique and expected outcome
• Explain what OHIP will cover and what your out-of-pocket costs will be
• Answer all of your questions about the procedure, recovery, and results

There is full transparency about costs. You will know exactly what OHIP covers and what you are responsible for before you make any decision.

Breast reduction recovery typically involves one to two weeks of limited activity, with a gradual return to normal over three to four months. Most patients report immediate relief from back and neck pain — often within the first week, once the weight is removed.

The results are permanent, though breast shape may change over time with aging, weight fluctuation, or future pregnancy.

For full procedure details, visit the dedicated Breast Reduction page.

For the portion not covered by OHIP, NPSC offers payment plans with biweekly or monthly options, no interest, no administrative fees, and no third-party financing. Visit Financing & Pricing for complete details.