Ruling: A cashier is not required to cover the cost of male breast reduction surgery
A man in Germany, affected by gynaecomastia – a condition where men's breasts enlarge to resemble a female breast – had his health insurance refuse to cover the costs for an operation. The man took his case to the Social Court Stuttgart, which dismissed his claim.
The verdict on the case was recently mentioned on the portal "anwaltauskunft.de". The court did not find evidence to support the man's claims of severe pain related to gynaecomastia, as there were no documented work absences, pain therapies, or prescribed pain medication.
The man argued that the enlarged breast caused him psychological distress, but the court did not consider this a valid justification for the cost coverage of the operation. Instead, they suggested that psychological treatment, such as psychotherapy, should be the primary method of addressing the distress.
The court acknowledged that gynaecomastia is an illness, but deemed milder measures, such as weight loss and physical activity, reasonable. They stated that there was no disfigurement from the man's enlarged breast, as it is not the subjective assessment of the affected person that counts, but whether a physical abnormality constantly attracts attention and causes the person to withdraw from social life.
In everyday life, enlarged breasts in adipose men may not be noticed in fleeting encounters. However, for those affected by gynaecomastia, it can cause psychological distress and physical pain, including tightness and sensitivity.
When statutory insurance in Germany refuses coverage for gynecomastia breast reduction, patients usually must pay privately or consider appealing with strong medical evidence. Alternatives include seeking private supplemental insurance coverage or going to more affordable clinics abroad that offer uninsured care packages for this type of surgery.
For example, in Turkey, Poland, or the Czech Republic, male breast reduction surgery can be substantially less expensive and may include comprehensive care packages. Many clinics and plastic surgery providers in Germany and these countries offer breast reduction surgery purely as uninsured care, meaning you pay the full cost yourself.
It's essential to consult your statutory insurance's terms, as some health insurers may consider coverage if the surgery qualifies as reconstructive rather than cosmetic – typically evidenced by a medical prescription or referral from a specialist. This is more common when physical health issues like severe pain or skin infections are present, but coverage remains exceptional and case-dependent.
- Despite the man's argument that gynaecomastia caused him psychological distress, the court did not accept it as a valid justification for the cost coverage of the operation, suggesting instead that psychotherapy should be considered as a primary method of addressing the distress.
- In cases where statutory insurance in Germany refuses coverage for gynecomastia breast reduction, patients might need to seek alternative solutions, such as paying privately, appealing with strong medical evidence, or going to more affordable clinics abroad for uninsured care packages.
- The court recognized that gynaecomastia could cause physical pain and psychological distress, but they found the man's symptoms insufficient to qualify for coverage, requiring clear evidence of documented work absences, pain therapies, prescribed pain medication, or significant psychological therapy sessions.
