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Can Insurance Cover Gynecomastia Surgery?

August 24, 2023

Gynecomastia is a condition where excess breast tissue and/or fat enlarge the chest. Gynecomastia surgery can reduce chest volume, improving self-image, confidence, and heightened masculine appearance. When considering gynecomastia, it is important to contact your insurance company to see if you have coverage for the cost. While most insurance companies do not cover the procedure, there are some that will cover a portion of the costs if they deem the surgery medically necessary. The condition often needs to be severe enough in terms of symptoms for coverage to apply. Nonetheless, it is definitely worth a call to your insuranceprovider. 

Understanding Gynecomastia 

Gynecomastia is caused by excess breast tissue in men. Genetics, medications, and hormonal factors all can trigger gynecomastia. When male breast tissue begins to fold, it causes a crease underneath the breast and downward-pointing nipples. 

Four different types of gynecomastia cause unwanted enlarged breast size in men. Classic gynecomastia is when enlarged breasts are caused by excess fatty tissue and breast tissue. Puffy nipple gynecomastia occurs when nipple puffiness is caused by excess breast tissue under the areola, causing the nipples to stick out. Fatty gynecomastia occurs when fatty tissue causes enlargement. Saggy gynecomastia happens due to excess skin causing chest enlargement.

Age Groups Affected

Gynecomastia is most prevalent in pubescent boys. Typically, the condition resolves without treatment in six months to two years. The condition may continue past the age of 17 in up to 20 percent of recipients. Adult gynecomastia can occur in men with hormone issues or who have taken certain medications and drugs known to cause enlarged male breasts.

Psychological Impact of Gynecomastia 

Gynecomastia can cause poor self-confidence in men. Men may feel incomplete, demasculinized, and embarrassed due to their body insecurities. Depression and anxiety can occur due to dissatisfaction with the body.

Non-surgical Gynecomastia Treatments 

Lifestyle changes 

Controlling hormone imbalances may affect the appearance of gynecomastia. If you are overweight, weight loss can reduce the appearance of gynecomastia. It is essential to discuss all options with your doctor before treatment.


Natural resolutions such as working out, creams, and pills rarely remedy the problem. The main component of gynecomastia is excess breast tissue which cannot be removed without surgery. 

Surgical Gynecomastia Treatments 

Joseph T. Cruise, MD, uses several male breast reduction techniques. Mild cases are often performed in-office, while severe cases are performed at an outpatient surgical center.


In some cases, liposuction is used to sculpt the upper chest by loosening the fat tissue in the body and removing excess fat.

Surgical Excision

Surgical excision is another method of treating gynecomastia. This method creates your desired chest contour through excision techniques.

For some individuals, a combination of the two can be used to achieve your desired results. Consulting with your doctor and assessing your gynecomastia is detrimental in creating your treatment plan. Recovery typically takes between four and seven days. 

Insurance Coverage for Gynecomastia Treatment 

Age Restrictions 

Many insurance policies require gynecomastia patients in their late teens or early 20s to be eligible for covered treatment. 

Determining Coverage Eligibility

If the chest is experiencing moderate or severe pain affecting your daily functioning, insurance may cover the surgery.  Sporting events and social events are not considered functional events.

If glandular breast tissue is the leading cause of the condition and not fatty tissue, insurance may provide coverage. If excess fat is the main cause, your insurance company may claim that you are experiencing obesity affecting the breast tissue and will require weight loss before the procedure.

You may be eligible for coverage if the gynecomastia persists after you stop taking substances that are known to cause gynecomastia. Drugs that induce gynecomastia include testosterone, asthma medication, anabolic steroids, marijuana, and calcium channel blockers.

Pre-authorization and Documentation 

Discussing the procedure with your doctor and insurance provider before surgery is essential. Insurance provider policies and guidelines vary from one to another. Prior authorization and medical documentation are necessary to maintain coverage. In some cases, you may need to appeal insurance denials.

Cost of Procedure

Gynecomastia correction typically costs between $7,500 – $16,000. This price range includes the outpatient facility fee, surgeon fee, anesthesia fee, supplies for surgery, and post-surgery follow-up visits. Cruise Plastic Surgery offers different payment and financing options based on the individual’s needs.

You can find additional financial assistance programs and grants. Gynecomastia support groups and online communities are available to share experiences and connect with others struggling with similar feelings.

Contact Us Today

At Cruise Plastic Surgery, we want you to have peace of mind while pursuing this life-boosting surgery. It is essential to plan your finances before seeking surgery. Talking to your doctor and insurance company about your gynecomastia condition is vital in developing your treatment. Dr. Cruise has years of experience and has performed over 5,000 gynecomastia surgeries.

If you are interested in gynecomastia treatment, contact us today to book a consultation with Dr. Cruise at Cruise Plastic Surgery in Newport Beach, California. 

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