Gynecomastia surgery, commonly known as male breast reduction surgery, is used to treat males who have oversized or overdeveloped breasts. Unlike many plastic operations performed only for aesthetic reasons, gynecomastia may be reimbursed by your health insurance in certain circumstances.
Gynecomastia is the abnormal expansion of glandular breast tissue in males and boys, popularly known as “man boobs.” An imbalance of testosterone and estrogen levels in the body is frequently the cause.
Other factors that can cause it to include age, lifestyle, genetics, illnesses, and drugs. Despite its prevalence, gynecomastia can cause severe emotional and mental suffering in males. As a result, they seek out treatment options such as surgery.
What Is Gynecomastia Surgery?
Gynecomastia surgery is a technique that is used to treat males who have excess breast tissue. It’s also known as a male breast reduction and is done by a plastic surgeon. The goal is to diminish the size of the breast(s) and alleviate other gynecomastia symptoms.
It’s also crucial to improve the appearance of the chest. Dr. Miguel Delgado, M.D., a skilled plastic surgeon, can assist in ensuring that scarring is kept to a minimum.
Does Health Insurance Cover Gynecomastia Surgery?
Gynecomastia surgery is classified as a cosmetic procedure by most insurance carriers. Unfortunately, this means that it may not be covered by your insurance coverage. However, in some circumstances, insurance companies will pay for gynecomastia surgery.
For example, if the reduction operation is judged required for medical reasons, it is more likely to be covered. To find out if you’re covered, talk to your doctor about your alternatives.
The major criteria in determining whether plastic surgery is covered by insurance are if your doctor and the insurance company agree that it is “medically necessary.”
Most cosmetic procedures aren’t covered because they aren’t medically essential, such as Portland breast augmentation and tummy tucks. However, in cases of breast reconstruction and gynecomastia, health insurance may fund the procedure.
Standards vary somewhat by the insurance company, but if a patient is under 18 and the following criteria are met, the gynecomastia surgery may be covered by your health insurance.
Note that most insurance policies require that the patient be considered for insurance coverage in their teen years or early 20s.
Examples of conditions that may qualify for insurance coverage include:
Health Insurance may cover reduction surgery if gynecomastia is caused by a serious medical condition. Some such conditions are:
- Cancerous tumors
- Non-cancerous tumors
- Liver or kidney disease
- Thyroid disorders
Gynecomastia can sometimes cause severe chest pain and discomfort. If a physical function is acutely impaired, reduction surgery may be eligible for coverage.
Some prescription medications can induce gynecomastia. Often, these medications are required to treat or manage other medical conditions. In these cases, gynecomastia surgery might be covered by insurance.
Although rare, some types of genetic disorders can also cause gynecomastia. Examples of this include Kennedy Disease or Klinefelter Syndrome. Gynecomastia in such cases may be an eligible medical reason for needing a reduction surgery.
Moderate To Severe Chest Pain
If the breast enlargement causes moderate or severe chest pain that creates a functional or physical impairment. However, the inability to participate in social events, sports, or athletic events is not deemed to be a functional or physical impairment.
Persistent Gynecomastia After Cessation Of Certain Drugs
The gynecomastia persists after the patient stops taking prescribed medications, recreational drugs, or substances that may cause gynecomastia. Some of these drugs include testosterone, asthma medication, anabolic steroids, marijuana, and calcium channel blockers.
Gynecomastia Must Be Present For Two Years Or More
The condition must be present for at least two years, and the evaluation of the causes using various laboratory testing has been normal. Some of the lab tests that may be used include hormone testing, liver enzymes, serum creatinine, and thyroid function studies.
Some health insurance coverage will only cover gynecomastia patients under the age of 18 if they have stopped taking all nutritional supplements, non-prescription pharmaceuticals, and other medications that have been linked to male breast growth.
In addition, if glandular breast tissue, rather than fatty deposits, is the major cause of the condition, insurance may fund the surgery. If fat deposits are present, the insurance company may argue that the problem is obesity, and you will need to reduce weight before the operation is considered.
Gynecomastia can sometimes be so severe that the skin begins to tear down. It can sometimes become infected, resulting in severe rashes. Only in the most severe cases of gynecomastia do these symptoms appear.
In this type of situation, an insurance company may be more likely to provide coverage. This is because medical intervention might be the only way to reduce pain and symptoms.
Before considering this surgery, talk to your doctor and health insurance company to determine if the cost may be covered.
Gynecomastia surgery costs may include:
- Anesthesia fees
- Hospital or surgical facility costs
- Medical tests
- Post-surgery garments
- Prescriptions for medication
- Surgeon’s fee
More than a fee is involved in your pleasure. Remember that the surgeon’s experience and your comfort with him or her are just as crucial as the ultimate cost of the procedure when picking a board-certified plastic surgeon in your area for gynecomastia surgery.
According to the American Society of Plastic Surgeons, the average cost of gynecomastia surgery is $4,239 in 2020. This is only a portion of the entire cost; it excludes anesthesia, operating room facilities, and other related costs. To establish your final charge, please contact the office of your plastic surgeon.
A surgeon’s fee for gynecomastia surgery will be based on his or her experience, the type of procedure used, and the geographic office location.
Most health insurance plans do not cover male breast reduction or its complications, but many plastic surgeons offer patient financing plans, so be sure to ask.
Gynecomastia Surgery Considerations For Teens
Many gynecomastia patients are in their late teens and early 20s. If they can prove the factors mentioned above, the surgery could be covered by insurance.
There also are some special considerations to keep in mind for this surgery for adolescents and young adults:
Rule Out Other Conditions First
Before you schedule gynecomastia surgery with your surgeon, talk to your pediatrician about other possible causes of the condition that could be treated non-surgically.
For example, if you are obese, losing weight will reduce the appearance of enlarged male breasts. You should consult with a weight loss specialist before considering surgery.
Have Realistic Expectations
Having male breast reduction surgery will give you a firmer and flatter chest and may reduce puffy nipples. But it won’t give you a chiseled, muscular chest.
When you look at before and after photos offered by your surgeon, pay attention to their ages. A 25-year-old’s “after” pictures will look different from an 18-year-old’s.
Also, remember that all patients are different, and even the best surgeon cannot alter your natural body shape and type.
Fast Recovery In Most Cases
In most gynecomastia surgeries, your surgeon can use Portland liposuction alone to achieve excellent results. Some surgeons use ultrasound liposuction to take out glandular tissue and fat through tiny incisions in the armpit.
Most patients need about five days off of work and school for recovery. Vigorous sports and exercise can be resumed after two or three weeks.
However, more extensive gynecomastia cases could require skin and tissue excisions, which will add time to the recovery.
Maturity and Responsibility Are Key
Ensuring the best possible results means that the young male patient needs to follow his surgeon’s instructions closely.
For instance, your surgeon may require you to wear a compression garment over your chest after the surgery for two weeks. Some younger patients may think this is bothersome, but it’s vital to keep the garment on to protect the incisions and reduce swelling.
Also, the patient needs to take a break from sports and other physical activities; that’s why many teenagers opt to have their procedure over the holidays.
Results May Or May Not Be Permanent
Having male breast reduction surgery before puberty comes with a risk that the results may not be permanent. Hormone levels in the body are still changing, so it’s possible that the condition can return.
Also, medication use and weight changes in the future can cause the breasts to enlarge again. That’s why many surgeons encourage patients to wait until they are after 18 to have the surgery. That is when they are most likely to be done with puberty and no longer need parental permission for the operation.
However, if the enlarged male breasts are causing emotional and social problems, it may be beneficial to have the surgery sooner rather than later, even if the condition could recur.
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