2024-09-07 17:28:31
Man boobs are usually not just a cosmetic problem – they can also be painful. However, a court ruled that they are not a disease.
When a man’s mammary gland becomes significantly enlarged, this is known as gynecomastia. This is not a disease that requires treatment, as the Hessian State Social Court (LSG) in Darmstadt ruled in a recent ruling. Statutory health insurance companies therefore generally do not have to cover the costs of removing breast tissue.
How did this decision come about? The plaintiff, now 52 years old, suffers from gynecomastia, a swelling of the mammary glands in men. His breasts are particularly sensitive to touch and hurt when he is at rest or during sport. He therefore applied to his health insurance company for reimbursement of the costs for the removal of bilateral breast tissue. However, the insurance company refused. In this case, it was only a slight breast enlargement without any inflammatory or ulcerative changes to the tissue. The operation was therefore not medically necessary.
The man unsuccessfully referred to his pain. In addition, the breasts were disfiguring, which also led to psychological stress. The LSG did not agree and ruled in favor of the health insurance company. Not every physical irregularity is considered a disease. In health insurance, the threshold for surgical intervention on intact body parts is particularly high.
There are neither orthopedic problems nor pathological skin changes. The man can manage his pain with non-prescription painkillers. Even that is not enough to justify an operation. In the case of psychological stress, he must primarily make use of psychotherapeutic services.
Furthermore, gynecomastia is not unusual, it occurs in more than half of all adult men, the Darmstadt judges stressed. In the plaintiff’s case, it is not so pronounced that the male breasts are disfiguring. That is only the case when the physical abnormality “makes itself noticeable even in fleeting encounters in everyday situations, almost ‘in passing'” and “regularly leads to the fixation of the interest of others.”