Will Aetna ever cover a gynecomastia operation on a male?

Question

From a recent post it seems I might have a hormonal imbalance as my Gynecomastia/puffy nipples isn't always there but comes and goes throughout the day and is usually worse later in the day. I have seen a Endcrinologist and he said that I would healthy, can my hormones be unbalanced and me be healthy like he said. How does this work? He also said my testosterone and estrogen levels were normal. Will Aetna cover to fix this issue? Will Raloxifene help to get rid of the lumps? Thanks

Ron Hazani, MD, FACS · Answer

In general, insurance does not cover gynecomastia procedures. Cost varies from surgeon to surgeon and depends on geographic location, OR time, anesthesia.....Seek a plastic surgeon who performs many of these procedures, has great reviews and photos, and is an expert in this field.
Good luck

James A. Hoffman, MD · Answer

I have never seen an insurance complany cover the gynecomastia. It does not sound like your Endocrinologist could document any health condition either. These are considered cosmetic procedures. If it bothers you enough to have it corrected, seek out a Board Certified PS that can show you many results of their patients. You will likely have to cover the fees yourself. Best Wishes

Sean Doherty, MD, FACS · Answer

In general, most insurance companies won't cover gynecomastia surgery. It's considered elective. However, you will need to check the particulars of your policy to know for certain. Best of luck.

Elliot W. Jacobs, MD · Answer

Although gynecomastia is listed as a medical condition, it is generally not covered by insurance.  You can look at the details of your own policy and see under what circumstances they may cover gynecomastia surgery -- but realize that it is rarely covered.The circumstances you describe (daily changes in your breasts) does not occur with any hormone fluctuations -- it is most likely a normal physiological process.For further information about gynecomastia surgery, please see my website (captioned below).Good luck!Elliot W. Jacobs, MD, FACSNew York City

Steven Wallach, MD · Answer

Gynecomastia surgery is not normally covered by insurance.  This is considered a procedure that would require you to pay yourself.

Robert L. Kraft, MD, FACS · Answer

In the absence of cancer, Aetna does not cover mastectomy for gynecomastia and liposuction is not covered under any circumstances.

Paul J. LoVerme, MD, FACS (retired) · Answer

From your description it does not seem that your endocrinologist feels that there is a hormone problem. I have not seen any insurance cover gynecomastia in the past 10-15 years. Be sure to find a Plastic surgeon who specializes in this surgery and is capable of performing 3D/4D contouring. It's not enough just to make your breast smaller or "flatter", it should be contoured.

Will Aetna ever cover a gynecomastia operation on a male?

Answers (7)