A regional court in the western city of Darmstadt rejected the claim of a 37-year-old woman who had been advised by several doctors to have breast reduction surgery to alleviate back pain and the social stigma she suffered.
Her health insurance plan rejected her application and she took it to court. The judge said in a written ruling that such procedures may only be covered if the bosom's size can be considered a physical deformation or leads to other health problems.
The court also found that "oversized breasts" were only to blame for back pain "in cases in which they were grossly disproportional to the dimensions of the rest of the body."
Because the patient was obese - 178 centimetres tall (five feet 10 inches) and weighing 116 kilogrammes (256 pounds) - the exception did not apply in her case, the court ruled.
A federal court had decided in 2004 that state health insurance must not cover the cost of breast reduction or augmentation surgery because "there is no norm for breast size or shape." It said that psychological problems stemming from breast size would have to be dealt with in therapy whose cost, though far higher than that for plastic surgery, is covered by most health plans.