The Schnur Scale is a recognized method used in plastic surgery for breast reduction. It helps determine the medical necessity of reduction mammaplasty, which is relevant for insurance coverage. Developed from a study of women undergoing breast reduction for medical reasons, the scale standardizes the assessment of breast tissue removal relative to a patient’s body size. This guides patients and providers on criteria insurance companies use to classify the procedure as reconstructive, not cosmetic.
Components of the Schnur Scale
The Schnur Scale relies on two key measurements: the patient’s Body Surface Area (BSA) and the anticipated weight of breast tissue to be removed. BSA is a calculated value derived from a person’s height and weight, often using formulas like the Du Bois method, and is expressed in square meters. This measurement estimates the total surface area of an individual’s body.
The second component is the weight of breast tissue a surgeon plans to remove from each breast, measured in grams. The Schnur Scale functions as a chart or table that correlates specific BSA values with corresponding minimum tissue removal weights. These two elements are fundamental for applying the scale, providing the objective data points required for evaluation.
Calculating the Schnur Scale Score
Calculating a Schnur Scale score involves comparing a patient’s Body Surface Area (BSA) and the quantity of breast tissue intended for removal. The process begins by determining the patient’s BSA from their height and weight measurements. Next, the surgeon estimates the weight, in grams, of breast tissue to be resected during the reduction surgery.
With these two values, the Schnur Scale chart or formula is consulted. This scale presents a range of BSA values alongside the minimum amount of breast tissue that should be removed per breast to meet criteria for medical necessity. For instance, a patient with a BSA of 2.00 square meters might find the scale indicates a minimum removal of approximately 628 grams of tissue from each breast. The calculation’s core is to determine if the projected tissue removal, relative to the patient’s BSA, places them at or above a specific percentile, most commonly the 22nd percentile, which is often used as a benchmark for medical necessity.
Interpreting Schnur Scale Results
The Schnur Scale score provides insights into the medical necessity of breast reduction. Its primary purpose is to determine if insurance providers will consider the surgery reconstructive rather than purely cosmetic. A key threshold for interpretation is the 22nd percentile.
If the calculated ratio of resected tissue weight to Body Surface Area falls at or above this 22nd percentile, the breast reduction is typically deemed medically necessary. This significantly increases the likelihood of the procedure being covered by health insurance. Conversely, if the score falls below this threshold, the surgery may be classified as cosmetic, often resulting in it not being covered by insurance.
Practical Considerations for Use
The Schnur Scale serves as an estimation tool for plastic surgeons and insurance companies evaluating breast reduction surgery. It is primarily utilized to navigate insurance approval by providing an objective measure of medical necessity. While widely adopted, the scale is a guide and not the sole determinant for surgical decisions or insurance coverage.
For example, strict adherence to the scale’s percentile requirements can sometimes pose challenges for individuals with genuine medical concerns if their measurements do not align perfectly. Additionally, the original study did not extensively cover patients with very high Body Surface Areas, leading to some extrapolated data for larger individuals. Despite these considerations, the Schnur Scale remains a common and practical method for assessing the relationship between breast size and overall body dimensions in reduction mammaplasty.