What To Know About NYSHIP Empire Plan and Male Breast Reduction

Empire Plan and male breast reduction or gynecomastia.
Male breast reduction surgery has become an increasingly popular treatment for gynecomastia. This excessive growth of breast tissue can cause emotional distress, physical discomfort, and low self-esteem. When considering male breast reduction surgery, there are a few things you should understand in advance: the details of the procedure, your insurance coverage, good candidates for the procedure, and alternative non-surgical treatments.

What is Male Breast Reduction Surgery?

Male breast reduction surgery is a procedure designed to correct gynecomastia — a condition in which male breast tissue becomes enlarged due to hormonal imbalances, medications, genetics, or other lifestyle factors. Gynecomastia surgery typically involves excision of glandular tissue and/or liposuction to reduce the size of the breasts, resulting in a flatter, more masculine chest contour. Depending on whether you have liposuction only or need glandular tissue removed, the procedure will usually be performed under general anesthesia and take 1-2 hours. Immediately after surgery, your post-operative care will often involve compression garments wrapped around your chest to help reduce swelling and promote tissue healing. Recovery time can vary, but you can expect to rest for between 1-2 weeks before you will be cleared to go back to your normal daily activities, and complete healing can take several months. Your plastic surgeon will give you a full list of dos and don’ts after your male breast reduction surgery to help improve and speed up your recovery time.

NYSHIP Empire Plan and Male Breast Reduction Coverage

Insurance coverage for male breast reduction surgery depends on several considerations, like who provides your coverage, what surgeons accept your insurance, and who is willing to work with out-of-network plans. Generally, insurance companies require evidence that the procedure is medically necessary rather than purely cosmetic. Specifically looking at NYSHIP’s Empire Plan and male breast reduction, the criteria to get the surgery covered include:
  • Persistent pain or discomfort: If enlarged breast tissue causes physical pain (e.g., back or shoulder pain) or skin issues like rashes or infections, insurance companies are more likely to cover the surgery.
  • Failure of other treatments: Patients who have tried non-surgical options, such as weight loss, starting or stopping medications, or hormonal therapy, with no improvement may qualify.
  • Breast tissue type: Insurance companies may differentiate between fatty breast tissue (pseudo-gynecomastia) and glandular tissue — the latter is more likely to be covered.
NYSHIP Empire Plan and Male Breast Reduction Surgery
Consideration Explanation
Eligibility Must be an active member of the NYSHIP Empire Plan or a covered dependent.
Condition Covered Gynecomastia (enlarged male breasts) is typically covered if deemed medically necessary.
Medical Necessity Requirements After other treatments (e.g., medication) have failed, surgery can be used to address physical pain and tenderness.
Documentation Required Physician’s letter explaining medical necessity, medical history, diagnostic tests, and photographs showing the condition.
Pre-Authorization Required. Approval must be obtained before surgery for coverage to be considered.
Covered Expenses Surgeon’s fees, anesthesia, hospital or surgical facility costs, post-operative care, and follow-up visits.
Out-of-Pocket Costs Subject to plan deductibles, co-pays, and co-insurance.
Excluded Cases Cosmetic-only procedures or cases without sufficient medical documentation may be excluded from coverage.
Appeal Process In case of denial, members can submit additional documentation and appeal the decision.

Working with a plastic surgeon’s office who has a skilled insurance coordinator can help you see what your specific plan covers and what documentation and pre-approvals are necessary before the procedure.

Who is a Good Candidate for Gynecomastia Surgery?

A good candidate to get male breast reduction surgery is someone who experiences significant physical discomfort or psychological distress due to breast enlargement. Men with a stable, healthy body weight who don’t have obesity-related gynecomastia are better suited for the procedure, as weight gain and fluctuations can affect the outcomes of surgery, especially breast reduction surgeries.

Be aware that surgery may not eliminate the condition completely, especially if there are other underlying causes for your gynecomastia. Consult your plastic surgeon early on. They can help you set realistic expectations about your surgical outcomes. To optimize healing after surgery, avoid smoking or using substances like steroids.

Empire Plan and male breast reduction or gynecomastia.

Alternative Treatment Options for Male Breast Reduction

Surgery is often the most effective treatment for moderate to severe cases of gynecomastia, but it isn’t the only option. Non-surgical alternatives can include:

  • Weight loss: When gynecomastia is due to excess fatty tissue (pseudo-gynecomastia), weight loss and exercise can reduce the appearance of enlarged breasts.
  • Medications: In cases where gynecomastia is caused by hormonal imbalances, prescription medications can adjust hormone levels.
  • Lifestyle modifications: Some find relief by reducing alcohol consumption, eliminating drugs that contribute to breast tissue growth (like steroids or other medications), and adopting a healthier lifestyle.

In mild cases, non-surgical treatments can offer relief. Moderate to severe gynecomastia often requires a more aggressive approach. If non-surgical methods have failed to produce the results you desire, male breast reduction surgery may be the option for you.

NYSHIP Empire Plan and Male Breast Reduction Surgery Made Easy at Harris Plastic Surgery

Male breast reduction surgery is an effective option for treating gynecomastia, offering both physical and emotional relief. While insurance coverage can be challenging to obtain, NYSHIP Empire Plan and male breast reduction surgery can be coordinated through our office with ease at Harris Plastic Surgery. If you have tried alternative treatments and still aren’t happy, call us to help you understand your options.

Harris Plastic Surgery - Your Breast Reconstruction Experts

If you’d like to learn more about your NYSHIP Empire plan and male breast reduction coverage, or are ready to schedule your consultation today. Contact us online or by phone/text if you have questions for the Harris Plastic Surgery Team.

Joanne Parrinello, Practice Manager

Joanne Parrinello is an expert patient care coordinator, with two decades of experience navigating the complex financial side of medically necessary breast reduction and reconstruction surgery. She acts as a guide to patients, helping them understand their options and their expected out-of-pocket expense. The insurance industry can be complex and filled with jargon that makes you feel like you need a translator. At Harris Plastic Surgery, Joanne is that translator.