How to Get Insurance to Pay for Gynecomastia Surgery | Expert Guide

Gynecomastia is a disorder that causes male breast tissue to expand. For men, it is frequently a source of shame and embarrassment. The number of guys seeking gynecomastia surgery has steadily increased throughout the years. We can also see an increase in the number of guys who wish to improve the appearance of their chests through surgery. Thus, we made this article to show you how to get insurance to pay for gynecomastia surgery.

Hormonal surges can also cause the formation of male breast tissue during adolescence. After puberty, part of this breast tissue diminishes, but the breasts stay larger in many cases. Asymptomatic gynecomastia affects 60 percent to 90 percent of children and 50 percent to 60 percent of adolescents.

Over 70% of males aged 50 to 69 years old are also affected. Puberty, excessive weight gain, anabolic steroid use in bodybuilders, and marijuana use are all common causes of gynecomastia. Male breast enlargement can also arise due to a variety of other drugs.

How to Get Insurance to Pay for Gynecomastia Surgery

How To Get Insurance To Pay For Gynecomastia Surger

Insurance companies typically perceive male breast reduction to be a cosmetic treatment. Thus reimbursement is frequently denied. However, for a few reasons, we still recommend patients apply for coverage. One possibility is that if enough men write to corporations requesting coverage for gynecomastia surgery, the situation will eventually change.

But the main reason we think it’s worthwhile for males to persevere is that their efforts are periodically rewarded. For example, a member of recently reported that he could persuade his insurance company to cover the cost of surgery.

Due to mental suffering, this man convinced his insurance company that he needed man boob surgery. We believe this is a sound plan. Guys, unlike women, are less likely to be persuaded by an argument centered on physical issues. However, it appears that, like women, males have the highest chance of success if they can demonstrate to their insurance company that they will save money in the end if they allow coverage for the necessary breast reduction.

Whether you’re a guy or a woman, dealing with physical or psychological troubles (or both), the concept is the same: Insurers have a vested interest in assisting consumers in obtaining the care they require.

Tips for Getting Insurance Coverage for Gynecomastia Surgery

So, how would you go about convincing your insurer that gynecomastia surgery is a worthwhile option for you? To get you started, consider the following suggestions:

  • Have your primary care physician write you a letter stating that your condition is chronic (not caused by medication or lifestyle changes) and causes your mental agony. You might be able to get a quicker response if you draft the letter yourself.
  • If your condition is causing you distress, consider seeing a counselor if you haven’t already, and be sure to make insurance claims for your appointments.
  • Seek advice from a licensed physician and obtain a surgical plan as well as a price quote for the treatment, as well as any additional materials they may have to support your claim.
  • Call your insurance provider and discuss coverage with them now that you have all of this information. Expect to be turned down, and if that happens, find out what the appeals process entails.
  • Gather all copies of charts, letters, and any other proof you have when drafting your appeal. Write your carrier a note describing the emotional trauma your condition creates and the consultations you rely on for support. If you stop going to the gym because you’re embarrassed, talk about it as well. Describe how you avoid certain activities and how your disease affects your well-being in other ways. Demonstrate how your mental health affects your physical health professionally and persuasively. On, you might want to connect out to guys who have already gone through the process. They can assist you in fine-tuning your plan.

What are the Major Signs and Symptoms of Gynecomastia?

What are the Major Signs and Symptoms of Gynecomastia

Gynecomastia most commonly affects both breasts, but it can also affect asymmetric or unilateral breasts. Breast self-exams frequently reveal a palpable, tender, firm, movable, disc-like mound of tissue behind the nipple-areolar complex that is not as hard as breast cancer.

Breast cancer should be suspected when noticeable masses are unilateral, solid, fixed, peripheral to the nipple, and accompanied by nipple discharge, skin abnormalities, or enlarged lymph nodes. A complete evaluation, including mammograms and MRI, is advised.

What Factors and Disorders Induce Gynecomastia?

A variety of medical disorders can also cause gynecomastia. These are some of them:

Malnutrition and re-feeding (malnutrition recovery): Both of these have been demonstrated to provide a hormonal milieu conducive to gynecomastia. Liver cirrhosis, on the other hand, impairs hormone metabolism and can result in gynecomastia.

Male sex organs (testes) disorders can lead to gynecomastia due to reduced testosterone production and considerably large estrogen levels. These conditions can be inherited, such as Klinefelter syndrome, or acquired due to trauma, infection, insufficient blood flow, or aging. Hormones that cause gynecomastia may be secreted by testicular tumors.

Chronic renal failure and hyperthyroidism are two more illnesses that may be linked to gynecomastia. In addition, other malignancies, besides testicular tumors, can occasionally produce hormones that induce gynecomastia.

Surgical Treatment for Gynecomastia

Surgical Treatment for Gynecomastia

When patients present a gynecomastia complaint, they typically report lumps and extra fat in the breasts. Liposuction of extra fat, surgical removal of residual glandular breast tissue through a cut at the nipple-areolar complex edge, and skin excision is the most common procedures used to remove breast tissues (in very large male breasts).

To confirm gynecomastia and rule out the possibility of male breast cancer, your surgeon should undertake a thorough physical examination of your breasts.

Preparing for surgery entails discontinuing any medications that raise your chance of bleeding, quitting smoking, and improving your nutrition to aid in your healing and recovery. Although most surgeons do the treatment under general anesthesia, it is also possible to execute it under oral sedation or local anesthetic. In addition, many surgeons utilize drains after surgery to prevent fluid accumulation. Compression vests and icing are also commonly used to relieve discomfort, reduce swelling, and prevent bruising.

What is the Price of Gynecomastia Surgery?

According to research, the estimated price of gynecomastia surgery is $4,250 in 2020. This is just a percentage of the total cost; anesthetic, operating room equipment, and other associated fees are not included. Don’t hesitate to contact your surgeon’s office to find out what your ultimate bill will be.

Gynecomastia surgery costs are affected by the surgeon’s expertise in the therapy selected. And the practice’s geographic location. Unfortunately, most insurance companies do not reimburse male breast lifts or complications that arise due to it. Many cosmetic surgeons, however, offer patient financing schemes, so be sure to ask.

The costs of gynecomastia surgery may include the following items:

  • Anesthesia charges
  • The price of healthcare or surgical facility
  • Medical screenings
  • Clothes to put on after surgery
  • Prescription medications
  • A physician’s fee

More than a fee is involved in your pleasure. Remember that the physician’s expertise and your acquaintance with him or her are just as crucial. This also encompasses the ultimate cost of the procedure when picking a board-certified doctor in your area for gynecomastia surgery.

Is the Surgery for Gynecomastia Covered by Health Insurance?

Most times, gynecomastia care is not covered by health insurance. Each insurance policy, however, is unique. Therefore, examine your policy thoroughly to identify what is covered. The American Society of Plastic Surgeons has released a policy document for doctors and insurers that outline the suggested criteria for gynecomastia reconstruction. Request a copy of this paperwork from your doctor to submit to your insurance company.

Frequently Asked Questions

Is gynecomastia surgery worth it?

Yes. Gynecomastia is a disorder in which males develop big breasts due to extra breast tissue. A prevalent myth is that large male breasts are fatty and slimmed down with diet and exercise. However, because gynecomastia involves breast tissue rather than fat, no dieting or exercise will eliminate excess tissue.

As a result, gynecomastia surgery (also known as male breast reduction surgery) is the only technique to fix this issue. In addition, for a smoother, more appealing contour, micro liposuction is frequently used in conjunction with excision.

Does the Army cover gynecomastia surgery?

Yes. TRICARE is commonly used by the Army to cover severe gynecomastia surgery.

Can gynecomastia re-grow after surgery?

Yes. After male breast reduction surgery, gynecomastia might reappear. Gynecomastia recurrence, on the other hand, is extremely rare. Almost all plastic surgeons who regularly conduct the operation agree on this, and research backs it up.

What causes most cases of gynecomastia?

Gynecomastia is a condition that results when male breast tissue swells due to some drugs and disorders. In addition, male breast tissue can grow large due to some hormones and treatments. For example, drug side effects can cause gynecomastia; however, they are usually caused by too much testosterone or estrogen.

Testosterone and estrogen levels should be monitored regularly with a doctor’s advice to ensure that the levels are in line with each other.

What is the reason behind the high cost of gynecomastia surgery?

Anesthesia is one of the main causes of the gynecomastia cost difference. Certain procedures, such as liposuction alone, can be performed under local anesthesia, which is less inexpensive, while others, such as gland excision, will necessitate sedation and general anesthesia.


In conclusion, gynecomastia tends to present diverse issues for men. And if you desire to learn how to get insurance to pay for gynecomastia surgery, the tips above will aid you immensely.



Adam Grabois is an expert in all aspects of Insurance and Property with 20 years of experience. He is a licensed broker of all lines including property, casualty, life, and health. As a licensed adjuster, he is well-versed in all aspects of insurance, and he owns All Needs Insurance agency in Florida.

He attended Tufts University where he earned his undergraduate degree, followed by a Master's degree from Columbia University.

Adam shares his breadth of experience by helping many businesses and individuals manage risk and protect themselves financially. He now shares this with the audience of the "Pro Insurance Info" website.

Articles: 281
error: Content is protected !!