For purely aesthetic reasons, health insurance companies have not yet had to pay for breast augmentation. For transsexuals, the legislator is now making an exception for the first time – under one condition.
Man-to-woman transsexuals are generally entitled to surgical breast augmentation if a certain size has not yet been reached. The prerequisite is that a breast with at least cup size A has not yet formed otherwise, for example through hormone treatment, as decided by the Federal Social Court (BSG).
The Kassel judges emphasized that the legislator had recognized transsexuality as an absolute exception. In order to “reduce her psychological suffering”, the claim to treatment therefore exceptionally also includes “an intervention in healthy organs”. A previous operation of the sexual organs is not necessary for this.
Genital surgery yes, breast augmentation no
In the first case, the health insurance company had paid for a 62-year-old transsexual for hormone treatment and genital surgery. Nevertheless, only very small breasts had formed. The health insurance company rejected a surgical enlargement. This is “an operation on healthy organs”; such operations are generally not paid for by the statutory health insurance funds.
In the second case, the health insurance had already paid for hormone treatments, an operative “face feminization” and two operations to change the voice. Genital surgery had been approved but had not yet been performed by the plaintiff.
The fund argued that hormonal changes following genital surgery could lead to the development of a female breast. At least before this, an operative breast augmentation is therefore impossible.
Operation only under one condition
The SPA rejected both arguments. Due to the exceptional position of transsexuals, the health insurance company may also have to pay for surgery on the actually healthy breast. However, this only applies if the transsexual cup size A “does not fill out completely”.
If however, an “undoubtedly gender-typical area” is reached; the right to a larger breast no longer exists. In the first case, the Hessian Social Court is still to examine this.
In the second case, the SPA also decided that the funds could not require a previous genital operation. The Kassel judges based their decision on recent rulings by the Federal Constitutional Court, according to which a solccurious operation may no longer be made a prerequisite for a change of name.