Is Gynecomastia Surgery Covered By Insurance

Gynecomastia surgery — a procedure that removes excess skin, fat, and glandular breast tissue from male breasts — is sometimes (but not always) covered by health insurance.

Generally speaking, the majority of plastic surgeries (procedures like breast lifts or liposuction, for example) are not covered by health insurance. This is because these types of surgeries are usually performed to improve an individual’s appearance, and, therefore, they are not deemed “medically necessary” by health insurance providers.

Gynecomastia, however, is different. Because this condition is generally regarded as abnormal (and when it persists, it may cause future pain, discomfort, and other problems), insurance providers sometimes have coverage options available.

The treatment of gynecomastia can be life-changing for many men. Gynecomastia surgery can reduce pain and discomfort, alleviate back and shoulder pain and improve posture, help men improve their self confidence, give men a wider variety of clothing options, and offer other benefits. If you require this surgery, it’s important to investigate all payment options available so that you can undergo the procedure and get back to living your best life.

When Is Gynecomastia Surgery Covered By Medical Insurance?

The most important thing to remember when it comes to plastic surgery and insurance coverage is that every health insurance company is different. Moreover, different health insurance plans have different levels of coverage.

Overall, male breast reduction surgery is covered by insurance when the procedure has been deemed “medically necessary”. This usually means that, for male adults, either malignancy has been suspected or all of the following are true:

The patient has been experiencing gynecomastia symptoms for at least one year.
A physical exam has been performed solely for the purpose of diagnosing gynecomastia, and the presence of excess glandular tissue has been identified.
Pain persists in the breast(s) and is being caused by gynecomastia.
The patient has at least Grade III or IV gynecomastia (as identified by the American Society of Plastic Surgeons).
If it is found that use of a substance or drug may have been causing the gynecomastia, use has been discontinued for at least half a year (six months) without any regression of symptoms.
Medical tests have been performed to rule out any possible underlying causes of the condition. If a cause has been found, the necessary treatment has been carried out and it’s been at least six months without regression of symptoms.

Once again, these criteria apply to some health insurance policies, but not all. Check with your provider and insurance policy to know for sure what requirements they have for gynecomastia surgery coverage.

Does Insurance Cover Gynecomastia Surgery for Minors?

If adolescent males experience male breast enlargement and the following criteria are met, gynecomastia surgery cost may be covered by insurance. However, it is again important to note that every insurance company is different.

The adolescent patient has been experiencing gynecomastia symptoms for at least two years.
A physical exam has been performed solely for the purpose of diagnosing gynecomastia, and the presence of excess glandular tissue has been identified.
Pain persists in the breast(s) and is being caused by gynecomastia.
The patient has at least Grade III or IV gynecomastia (as identified by the American Society of Plastic Surgeons or ASPS).
If it is found that use of a substance or drug may have been causing the gynecomastia, use has been discontinued for at least half a year (six months) without any regression of symptoms.
Medical tests have been performed to rule out any possible underlying causes of the condition. If a cause has been found, the necessary gynecomastia treatment has been carried out and it’s been at least one year without regression of symptoms.

Can Adolescent Gynecomastia Go Away on Its Own?

Some insurance companies will cover gynecomastia surgery for adolescents when the above criteria are met. However, it’s also important to remember that many pubertal gynecomastia patients will see symptoms disappear on their own.

In these situations, the

growth of excess glandular tissue is related to the natural and normal hormone changes that occur during puberty. Given time, chest contours will usually return to normal within a few months to a year. Of course, if they do not and gynecomastia persists, it’s wise to consult a plastic surgeon for diagnosis and treatment options.

How Much Does Gynecomastia Surgery Costs?

Every patient is unique when it comes to gynecomastia. Some patients require the extraction of glandular breast tissue only while other patients may require liposuction of fat and excess skin removal as well. These variations in the condition and required treatments mean that the cost of gynecomastia surgery may be drastically different from patient to patient.

Still, the average cost of gynecomastia surgery cost ends up being between $4,500 and $7,500. The American Society of Plastic Surgeons estimates gynecomastia surgery cost, on average, $4,239. Keep in mind this average does not include the cost of the surgical treatment facility, anesthesia-related expenses, and other costs.

Questions and Answers

Is Gyno Surgery Covered By Insurance?

Rarely, the process might receive coverage, typically in cases where the patient is under 18 years old. However, it’s important to note that insurance companies may only contemplate covering the procedure, and it is not assured.

How to Get Gynecomastia Surgery Covered by Insurance?

The key consideration for insurance cover gynecomastia hinges on the determination of whether it is deemed “medically necessary” by both your doctor and the insurance provider. While standards may slightly differ among insurance companies, if a patient is under 18 and specific criteria are satisfied, health insurance cover gynecomastia surgery.

It’s worth mentioning that the majority of insurance insurance plans stipulate that patients should be evaluated for insurance coverage during their teenage years or early 20s.

Schedule Your Gynecomastia Consultation Today

The condition of gynecomastia can be alleviated with male breast reduction surgery. Alleviate your pain and discomfort, enhance your chest contours, and improve your confidence overall with this procedure.

Call today to schedule your consultation appointment with board-certified plastic surgeon Dr. Ashley Steinberg.