How to get insurance to pay for male breast reduction

How to get insurance to pay for male breast reduction

Gynecomastia surgery, also called male breast reduction, is performed to correct enlarged or overdeveloped breasts in men. Unlike many plastic surgeries that are performed for cosmetic reasons alone, gynecomastia may be covered by your health insurance in some situations.

Below is more information on this aspect of the surgery, as well as related information.

factors that determine whether health insurance covers gynecomastia

The main factor in determining whether plastic surgery is covered by insurance is whether it is deemed “medically necessary” by your doctor and the insurance company.

Most plastic surgeries, such as portland breast augmentation and tummy tucks, are not covered because they are not medically necessary. but in cases of breast reconstruction and gynecomastia, the surgery may be covered by health insurance.

Standards vary somewhat by insurance company, but if a patient is under the age of 18 and the following criteria are met, gynecomastia surgery may be covered by their insurance.

Please note that most insurance policies require that the patient be considered for insurance coverage in their late teens or early 20s.

moderate to severe chest pain

if breast enlargement causes moderate or severe chest pain leading to functional or physical impairment. however, the inability to participate in social, sporting, or athletic events is not considered a functional or physical impairment.

persistent gynecomastia after stopping certain medications

Gynecomastia persists after the patient stops taking prescription medications, recreational drugs, or substances that can cause gynecomastia. Some of these medications include testosterone, asthma medications, anabolic steroids, marijuana, and calcium channel blockers.

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gynecomastia must be present for two years or more

The condition must be present for at least two years and evaluation of the causes by various laboratory tests has been normal. Some of the laboratory tests that may be used include hormone tests, liver enzymes, serum creatinine, and thyroid function studies.

other factors

Some health insurance policies will only cover gynecomastia patients under the age of 18 when they have stopped taking all nutritional supplements, over-the-counter medications, and others known to have a male breast enlargement side effect.

In addition, insurance may cover the surgery if glandular breast tissue is the primary cause of the condition rather than fat deposits. if there are fat deposits, the insurance company may say obesity is the problem, so you’ll need to lose weight before considering paying for surgery.

Before considering this surgery, talk with your doctor and health insurance company to determine if the cost may be covered.

considerations about gynecomastia surgery for adolescents

Many patients with gynecomastia are in their late teens and early 20s. If they can prove the factors listed above, the surgery might be covered by insurance.

There are also some special considerations for this surgery for adolescents and young adults:

discard other conditions first

Before scheduling gynecomastia surgery with your surgeon, talk to your pediatrician about other possible causes of the condition that could be treated without surgery.

For example, if you are obese, losing weight will reduce the appearance of enlarged man boobs. You should consult with a weight loss specialist before considering surgery.

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have realistic expectations

Male breast reduction surgery will give you a firmer, flatter chest and may reduce puffy nipples. but it won’t give you a chiseled, muscular chest.

When looking at the before and after photos provided by your surgeon, pay attention to their ages. ‘After’ photos of a 25-year-old will look different than those of an 18-year-old. Also, remember that all patients are different, and even the best surgeon cannot alter his natural body shape and type.

quick recovery in most cases

In most gynecomastia surgeries, your surgeon may use portland liposuction alone to achieve excellent results. Some surgeons use ultrasound liposuction to remove glandular tissue and fat through small incisions in the armpit.

Most patients need about five days off work and school to recover. vigorous sports and exercise can be resumed after two to three weeks.

However, more extensive gynecomastia cases may require skin and tissue excisions, which will add time to recovery.

maturity and responsibility are key

Ensuring the best possible results means that the young male patient must follow his surgeon’s instructions to the letter.

For example, your surgeon may ask you to wear a compression garment over your chest after surgery for two weeks. some younger patients may find this annoying, but it is 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 teens choose to have their procedure done while on vacation.

results may or may not be permanent

Male breast reduction surgery before puberty carries the risk that the results may not be permanent. Hormone levels in the body are still changing, so the condition may return.

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Also, medication use and future weight changes can cause the breasts to re-enlarge. that’s why many surgeons encourage patients to wait until they are over 18 years old to have surgery. this is when they are most likely to have finished puberty and no longer need parental permission for the operation.

However, if enlarged male breasts are causing emotional and social problems, it may be beneficial to have surgery sooner rather than later, even if the condition may recur.

request a gynecomastia consultation

Thinking about having a gynecomastia procedure in portland? dr aric aghayan is proud to serve portland area patients in his practice, after plastic surgery. he’ll go over your options, your goals, and more to determine if you’re an ideal candidate for gynecomastia.


everything you need to know about man boobs. (2019). consulted at https://www.medicalnewstoday.com/articles/326637

enlarged breasts in men – gynecomastia. (North Dakota.). retrieved from https://www.mayoclinic.org/diseases-conditions/gynecomastia/diagnosis-treatment/drc-20351799

what men should know before undergoing gynecomastia surgery. (2019). accessed at https://www.plasticsurgery.org/news/blog/what-men-need-to-know-before-have-gynecomastia-surgery

gynecomastia insurance coverage. (North Dakota.). viewed at https://www.uhcprovider.com/content/dam/provider/docs/public/policies/signaturevalue-mmg/gynecomastia-treatment-sv.pdf


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