On What Grounds, Can a Tummy Tuck and a Male Breast Reduction Be Classified As Medical Procedures?

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.

If you're inquiring as to how you can get your gynecomastia correction and tummy tuck covered by insurance, this is very difficult to do.  Your gynecomastia would have to be from a tumor or trauma as well as the excess skin of your abdomen.

Generally tummy tucks and male breast reductions are not medically necessary. Some insurances will cover a tummy tuck in a massive weight loss patient who has lost over 100 pounds and has rash and yeast type of infections under the abdominal skin folds. I have never seen male breast reductions covered as medically necessary.

Both Tummy Tuck and Male Breast Reduction are typically cosmetic (not medically necessary) procedures.

These procedures may become medically indicated (either necessary, recommended, or medically appropriate) when:


There is significant pain that may be improved, such as with a large hanging area of excess skin

A hernia or severe loss of support of the abdominal muscles is present

Excess skin is causing problems with rashes, irritation or infection (or perhaps pain)

True feminization of the male breast shape that causes significant psychological disturbance


Good News / Bad News

The bad news is that medically indicated does not mean that an insurance company will pay for a procedure (as more often than not they will not pay or reimburse these procedures).

The good news is many people are able to use flexible spending account or health savings account funds for a medically indicated procedure, even when medical insurance does not provide coverage.

Hope this helps,

Nick Slenkovich, MD FACS

 

Until about 10 years ago, insurers would consider payment for gynecomastia surgery. They have implemented more restrictive guidelines and the only basis for coverage would be genetic markers establishing high risk for breast cancer.  The code for the surgery is mastectomy for gynecomastia.  Barring this, the surgery, whether resection of glandular tissue or liposuction, would be considered cosmetic.

Tummy tuck is also subject to more restrictions.  A ventral hernia established by an MRI would be covered but the cost of this is minimal when compared with the tummy tuck.  After bariatric surgery, some carriers will cover excision of the panniculus, or hanging apron of abdominal skin, but only upon documentation that rashes have been medically treated and are intractable.

The best way to find a ground for possible,but not likely, insurance coverage is to go to the official "American society of plastic surgeons" web site. Ask them for "position papers about gynecomastia surgery".Those papers will clarify when one may be eligible for insurance coverage. wikipedia gynecomastia may also give you same clues.

There is a high degree of variability among insurance carriers. I have seen young maies with severe gyencomastia covered and abdomens with heavy pannuses covered.  Best to contact your carrier with a good letter detailing your medical issues and a supporting set of standardized photos illustrating your problems.

Usually, male tummy tucks and breast reductions are cosmetic procedures that are not covered by insurance, including when performed after weight loss.  If there were severe skin rashes underneath an apron of excess abdominal skin (called a pannus), insurance might cover the excision of the excess skin, but not an entire tummy tuck.  Regarding the breast reduction, in my experience the only time this has been covered is in young male patients with a painful localized mass of breast tissue.