Have gynecomastia/pseudogynecomastia. Is this covered by OHIP if my quality of life is impacted and there is some pain? (Photo)

I have had it since i was a teenager and it has never gone away. I have puffy nipples and some pain when pressing on the chest. I have worked out and been down to single digit body fat and still showed then. it seems to cause what looks to be a lot of chest fat as well wrapping under the armpit area. It has made me feel uncomfortable and ashamed to take my shirt off in front of people.

Doctor Answers 2

Insurance Coverage and Gynecomastia Surgery

Typically, gynecomastia surgery is not always covered by many insurance or healthcare programs. If it is, it can take some time to acquire approval as criteria can be restrictive. If approved, it's possible to be reimbursed by the insurance company after the surgery. Nevertheless, most plastic surgery offices offer convenient finance plans that allow patients to pay a low monthly payment. 

According to the American Society of Plastic Surgeons the average #cost of #gynecomastia surgery can vary widely. #Surgery quotes should include the procedure itself, operating room facilities, anesthesia fees, surgeon’s fees, medical tests, post-surgery garments, prescription medication and other related costs.  Costs will also vary with geographic location. Estimated costs can be found here on RealSelf.com, PlasticSurgery.org or Surgery.org.

It is imperative you select a plastic surgeon who is #board-certified and has a great deal of experience with male breast #reduction. Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your procedure. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Have gynecomastia/pseudo gynecomastia. Is this covered by OHIP if quality of lift is impacted?

Thank you for sharing your question and concerns and I am sorry to hear of the symptoms that your chest has caused.  It does appear that you have either gynecomastia or pseudogynecomastia that would best be treated with liposuction and glandular tissue excision.  Unfortunately gynecomastia correction is rarely covered by any insurance as it is deemed "not medically necessary," but you may wish to reach out to your carrier and see if they cover the procedure at all, and if they do what their stipulations are.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 65 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.