Ruling: Male cashier not obliged to cover costs of chest reduction surgery
In a recent ruling, the Baden-Württemberg State Social Court acknowledged that gynecomastia, a condition where men's breasts enlarge to resemble a woman's, is a disease. However, the court did not find the man's appeal for surgery coverage to be justified.
The man, who has been suffering from a benign enlargement of the breast glands for years, reported pain and psychological suffering due to the enlarged breast. Despite this, the court did not find the man's described pain severe enough to warrant surgery coverage.
The court's decision was based on the fact that enlarged breasts are common in adipose men, and they would not be noticed in fleeting encounters. Furthermore, the court ruled that there was no disfigurement due to the enlarged breast, as it does not attract constant attention in everyday life.
The man had also appealed to the Stuttgart Social Court, but his complaint was dismissed. The court's ruling highlighted the details on the "anwaltauskunft.de" portal.
In determining disfigurement, the court considers whether a physical abnormality causes the affected person to withdraw from social life. In this case, the court did not find that the man's condition met this criterion.
Health insurance generally covers gynecomastia surgery only when it is deemed medically necessary, which requires specific criteria such as persistent symptoms, confirmed glandular tissue, and failure of non-surgical treatments over at least six months. Milder treatment options for gynecomastia, such as weight loss and physical activity, were considered reasonable by the court.
However, insurance coverage for these milder, non-surgical treatments is typically not included or considered for reimbursement, especially if surgery is refused. The man could not provide records of work absences or pain therapy, and there were no prescribed pain medications mentioned.
Hormone therapy was unsuccessful in treating his condition. Psychotherapy is suggested as a primary treatment for the psychological distress in the ruling. The court did not find the psychological distress described by the man to justify cost coverage for the operation.
In summary, while surgery can provide relief for those with gynecomastia, the man's appeal for health insurance coverage was denied due to the court's determination that his condition did not meet the criteria for medical necessity. Patients should confirm specific details with their insurance provider, as policies vary.
References:
- drsteinberg.com - Gynecomastia Surgery Coverage, 2025
- drsteinberg.com - Breast Reduction Insurance Coverage, 2025
Science has recognized gynecomastia as a medical condition that not only causes physical discomfort but also mental health issues. The case of the man's rejection for surgery coverage by the Baden-Württemberg State Social Court brings light to the complexities in the health-and-wellness sector, where mental health and men's health remain crucial aspects of consideration, especially for gynecomastia cases.
