A high school senior from Pittsburg, Pennsylvania, became an outstanding golfer in high school and stood a good chance of getting a full scholarship at a college for playing on the golf team.

But something was holding her game back -- her extremely large breasts were in the way of her swing. Moreover, the added weight of the pendulous breasts caused poor posture, back problems and terrible skin rashes. In some women, pendulous, ultra-heavy breasts even create permanent grooves in their shoulder bones due to the extra ballast on the bra straps. The Solution? Surgically reduce the breasts.

“The minimum requirement for insurance coverage is removing 450 grams (about 16 ounces,) from each breast,” New York plastic surgeon Elliot Jacobs, M.D., F.A.C.S. told CosmeticSurgery.com. “Moreover, huge breasts are connected with long-term health problems like curvature of the spine and spinal arthritis. Plus, the teasing from boys is non-stop, sports and other activity are hampered and clothing doesn’t fit well.”

The good news: when all those conditions are present, most health insurance firms will pick at least some of the tab for a breast reduction. The procedure falls into an area between plastic and cosmetic surgery known as functional plastic surgery.

While breast reductions currently lead the list of functional plastic surgery operations, a few other surgical rejuvenations can also make the patient look and function better while receiving at least some insurance coverage. Typical procedures include the repair of crooked noses to allow better breathing and reductions of hanging upper eyelids to help patients see more clearly. Reconstructive surgery -- like cleft palate repair -- is usually limited to repairing abnormal bodily structures caused by birth defects, injuries, infection, tumors or disease. Most reconstructive surgeries are done with restored function uppermost in mind but may also create a more normal appearance along the way. For instance, a child’s cleft palate repair is medically necessary so the child can eat normally but it also makes the youngster look better, too.

Usually, a crooked nose results in blocked breathing passages. The operation to open those passages to restore normal airflow – but without beautifying the nose – is known as “Septoplasty.” In most cases, a crooked nasal septum – the wall that separates the two nostrils -- has been injured, often in childhood. As the person grows, the deformity becomes larger and eventually blocks airflow. Septoplasty repairs the block but probably won’t improve the appearance of the nose -- although it’s easy enough for a qualified plastic or cosmetic surgeon to do an aesthetic procedure at the same time.

“Another leading – and growing, according to the American Society of Plastic Surgeons statistics -- request for insurance company coverage is for body lifts, after bariatric surgery,” says Dr. Jacobs.

Many more morbidly obese people – defined as those who have a Body Mass Index of 40 or over – are having operations to drastically reduce the amount of food their stomachs can hold. Afterwards, most typically lose anywhere from 100 to 300 or more pounds.

A typical patient described her plight: “After I dropped 155 pounds, it was like having a size 26 skin on my size eight body.”

But a huge weight loss also leaves large sheets of stretched skin hanging from the neck, arms, chests, legs and abdomen. It almost always requires another extensive surgical procedure known as body lifting, or body contouring.

Other approved functional plastic surgeries include repairing improperly healed burns and scars which can limit the range of motion of a hand, leg or arm. The surgical repair also improves the patient’s appearance. Other burns that may be eligible for insurance coverage are burn scars around the mouth which may prevent the patient from opening the mouth.

Other covered functional repairs that also enhance the patient’s appearance include breast reconstructions after cancer surgery, ear replacements for people who have been in accidents or fires and hand surgeries to replace fingers and finger tips lost in accidents. Some surgeons consider asymmetrical breasts a functional surgery because when one breast is heavier, the woman’s back can become unbalanced, putting undue pressure on her spine.

In addition to a droopy upper eyelid that obstructs vision, a lower eyelid can hang out on the cheek or turn inward and irritate the eyeball with its eyelashes. Those conditions are usually not considered purely cosmetic and thus are covered even though the surgery makes the patient look much, much better.

One thing’s for sure: with somewhere between nine and 11 million plastic and cosmetic procedures done in 2004, more consumers are going to be asking their insurance companies which are covered.

You just can’t lose by looking and functioning better.

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© 2005 HealthNewsDigest.com