I have Gynecomastia, The problem is recently it has become incredibly painful, the surgeon I have seen said that it won't be covered because it is cosmetic? I would like to know how it counts as cosmetic if it is painful

Gynecomastia. is young males is often painful!! The good news is that it will gradually disappear!! Try ICE ...or HEAT (whichever works best)

Hope this is helpful
Dr Z.
Gynecomastia. in a male is unusual enough that this determination would be highly individualized. I am not familiar with insurance coverage in South Africa, but here pain relief would certainly be considered in the determination of insurance coverage or not. It sounds like you need to have an informative discussion with the insurance carrier about what their parameters are and then revisit your surgeon.