Author Topic: Gynecomastia Forum - Prolactin Induced Gyno Insurance Coverage & Recurrence  (Read 4827 times)

Offline DrBermant

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Dear Dr. Bermant,

I first want to thank you for your active participation on various forums like - and -.
As from my readings online about your knowledge and experience in gyno removal, I thought I needed to ask a true expert on getting my prolactin induced gyno removal covered by insurance.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Jane was my office manager and managed the insurance issues, but now we are both retired. You are welcome to ask here on the forums as to if there are any new developments in that aspect of medicine.

There would be 2 aspects to consider. What criteria are needed before any one plan "covers" gynecomastia? That seemed to change from plan to plan and over time according to what Jane told me. The second factor was was what the insurance company felt the operation worth paying enough to cover the advanced sculpture that became my trademark?

Some of the complications I saw from unhappy patients were from having someone do their first operation for insurance, and then they came to me to try to address the mess.  Sometimes it was a problem of contour, other cases, the problem was not stabilized, surgery done, and the problem came back. Now I did not investigate what those doctors were paid, nor other such factors such as competence and so forth, but a factory quick fix approach was not for my style of practice.

I do not envy anybody's task of finding out about insurance issues. You are welcome to post your questions here for for others to comment about, share experiences, and learn from each other.

As stated, I have prolactin induced gyno that had never gone away after puberty. I went through puberty a little later than those my same age. I dont think this alone is enough to get insurance involved at all. However, at about 12 I was prescribed Adderall for my ADHD. Being classified as an amphetamine, I understand it stimulates the neurotransmitters norepinephrine and dopamine. My point being that to every high, there is a low. As you know, an increase in prolactin can be linked to lower amounts of dopamine.
Later at about 15, I was prescribed Wellbutrin for an anti-depressant. Again, this particular anti-depressant specifically targets dopamine. I feel that this anti-depressant is used hand-in-hand with Adderall to stabilize dopamine levels affected by the spikes in dopamine from Adderall. So my question is; is it possible that these dopamine agonists destabalized my dopamine levels resulting in increases in prolactin, causing my gyno to never completely subside? If the information i perceive to understand is correct, could these medications be the cause of why my gyno never went away. Is this reason enough to have this surgical removal be covered by insurance?

Being treated for depression, this problem of gyno defiantely isnt helping me feel any better.

Any response would be greatl

An imbalance of Prolactin hormone is one of many Causes of Gynecomastia. The one I saw most of were the Prolactinoma Tumors. I saw quite a few of these Prolactinoma causing Gynecomastia. Timing of surgery is a major factor as discussed in this thread: Gynecomastia Forum - Prolactinoma Tumor Causing Gyno - When Male Breast Surgery?

Each patient failed my Red Flag System for surgery and was sent to an Endocrinologist. Most were complex enough to require an Endocrinologist specialist. I wanted a "green light" to proceed with surgery. Although not a guarantee, that was the best I could design for my patients. That is the individual I suggested my patients ask about hormone balance interrelationship issues. Perhaps we will be able to convince an Endocrinologist to join our forums to share their expertise.

In general though, gland stimulated during an imbalance of hormones swells and then grows. Returning the balance can remove the swelling. However, what has grown and entered the fibrotic phase, remains. The additional problem for some patients is that their problem may not be permanently stabilized, and there may be new growth issues over time. That is why I referred these complex cases to specialists comfortable with these unusual situations. To give the patients the best possible chance to lower the risk of recurrence. Here is a discussion about recurrence and regrowth:
Gynecomastia Revision Forum - Should Surgery Prevent Recurrence? Growing Again

Thank you for your comments about my efforts to educate the public. I have moved them here where I could build better tools to help people learn. Check out our resources, the floating navigation bar is filled with details available to posters at all times and changes depending on what part of the forum one is using. You are welcome to use, share, build what we have here to get your questions better answered.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction
Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
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