Gyno surgery covered by OHIP?

Question

Many of the surgeons I've chatted with in the GTA say that they have adopted this more advanced technology called "bodytite" or "smartlipo" which is apparently not covered by OHIP. What is the method is covered by OHIP? (I'm guessing it's the one where the surgeon makes a 2 cm incision under the areola) I heard that it's only covered if I had only the breast gland tissue excised OR an endocrine hormone imbalance. If that is true, how would I test for imbalance?

Jed H. Horowitz, MD, FACS · Answer

In the U.S., 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.

Jeffrey D. Wagner, MD · Answer

OHIP may be very different from the US, so you will have to inquire directly, probably through a consultation with a local plastic surgeon.  However, in the US, insurance only very rarely covers this type of surgery.

Richard Zienowicz, MD · Answer

It is very challenging to have this procedure covered by insurance. Also, in some cases the surgeon's that will accept insurance for these cases may not be the most qualified. You may want to check into some long term financing options available to help with covering the cost. Good luck.

Larry S. Nichter, MD, MS, FACS · Answer

You should meet with a Board Certified Plastic Surgeon to discuss your options and to decide which course of treatment is best for you. Here are some guidelines about the cost of the surgery: Male breast reduction cost factors vary significantly for a number of good reasons: Prices vary greatly because the surgery itself encompasses a wide range of techniques that can be performed to different extents. My recommendation is to first find the most qualified surgeons where you want the surgery performed that are board certified by the American Board of Plastic Surgery you trust, then compare prices between them. See the below link on suggestions on how to find the most qualified plastic surgeon for your procedure. General Factors that influence the price of plastic surgery include:1. Location - Will it be performed in a hospital with an overnight stay, an independent out- patient facility or a doctor’s office? Geographical location also has a significant influence. RealSelf has average charges for most areas of the USA and Canada.2. Type of Anesthesia - local, IV sedation or General Anesthesia? Will a board certified anesthesiologist, nurse anesthetist, or an RN be used?3. Experience and training of your surgeon. The best and longest trained is most often a plastic surgeon board certified by the American Board of Plastic Surgery4. Length and Complexity of Surgery - how difficult will your surgery be and how long it will take, etc. Will other complementary procedures also be also performed during the same surgery?#malebreastreduction#gynecomastia

Nelson Castillo, MD · Answer

Thank you for your question.  Though I do not know all of the rules of Canadian insurance, I would recommend you make an appointment with an ASPS board certified plastic surgeon in your area for a consultation.  They will not only be able to provide you with requisite lab work to rule out an organic cause for your gynecomastia, but also offer you treatment recommendations.  In the US insurance coverage of gynecomastia is rare.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Gynecomastia can be covered by some insurance companies but requires1)breast pain that is not controlled with conservative measures and causes difficulty with physical activity.2)breast deformity that causes psychological issues documented over six months.

R. Stephen Mulholland, MD (retired) · Answer

Dear icecreem,

Thank you for your clinical
post.  Ontario Health Insurance Plan will
dramatically and radically from U.S. insurance schemata so U.S. physician
advice in this matter will be of relatively little use.  Ontario Health Insurance Plan, in my
experience, rarely covers gynecomastia anymore. 
There must be significant and documented blood tests showing hormonal
imbalance, endocrine tumours, significant gynecomastia with ptosis with
pre-approval of photos.  It is tougher to
get this approved than in previous decades, but you should seek out an Ontario
Health Insurance Plan physician to be an advocate for your case.  It may end up that you’re not covered by
insurance and you need to pay for this out of pocket or use finance companies
such as iFinance Canada, also called Medicard to spread out and defray the cost
of this over 60-72 months.

I hope this information is of some
assistance and best of luck.

To find out more, please visit the
link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Gyno surgery covered by OHIP?

Answers (7)