position: fixed; No other operation-related complications were observed. Aesthetic Plast Surg. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. 18th ed. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an out-patient; however, this was not statistically significant (p = 0.07). 1998;26(1):61-65. Aesthetic Plast Surg. In addition, Nguyen et al (2004) ignored a wealth of published evidence of the effectiveness of physical therapy, analgesics and other conservative measures on back and neck pain generally. Evidence-based clinical practice guideline: Reduction mammaplasty. 2007;36(2):497-519. # color: white; #backTop { Reduction mammoplasty for asymptomatic members is considered cosmetic. Ann Plast Surg. Fischer S, Hirsch T, Hirche C, et al. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. When seeking preauthorization for a breast reduction, your goal is generally twofold. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. However, it is unclear if there is any evidence to support this practice. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. In a systematic review, these investigators examined the role of radiotherapy in this context. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Management of gestational gigantomastia. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. 2000;45(6):575-580. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. OL LI { Fagerlund A, Cormio L, Palangi L, et al. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. 2006;118(4):840-848. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. 2001;76(5):503-510. 2015;49(6):363-366. 2007;356(5):479-485. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Schnur PL, Schnur DP, Petty PM, et al. Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. border-radius: 4px; Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Ann Chir Plast Esthet. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. A cohort study of breast cancer risk in breast reduction patients. This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. Philadelphia, PA: W.B. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Surgical treatment of gynecomastia: Complications and outcomes. Prepubertal gynecomastia linked to lavender and tea tree oils. Breast J. Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Plast Reconstr Surg. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Measuring health state preferences in women with breast hypertrophy. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. 2005;58(3):286-289. Reduction mammaplasty: The need for prospective randomized studies. Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . Breast J. These preliminary findings need to be validated by well-designed studies. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. 2000;44(2):125-134. Surgical management of gynecomastia--a 10-year analysis. These investigators searched the literature on the treatment of Simon's grade I and II gynecomastia in PubMed, Scopus, Science Direct, and Cochrane using keywords "gynecomastia" and "liposuction". The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Ann Plast Surg. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. PDF 0185 Breast Reconstructive Surgery (1) - Aetna Yao Y, Yang Y, Liu J, et al. of the following criteria must be met: Plast Reconstr Surg. Ann Plast Surg. 2010;125(5):1301-1308. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna margin-top: 38px; There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). background-color:#eee; } Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Oxford, UK: National Health Service (NHS); October 2008. In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. Plast Reconstr Surg. The condition not only must be unresponsive to dermatological treatments (e.g., antibiotics or antifungal therapy) and conservative measures (e.g., good skin hygiene, adequate nutrition) for a period of 6 months or longer, but also must satisfy criteria stated insection I above. Plastic Reconstruct Surg. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. ol.numberedList LI { American Society of Plastic Surgeons (ASPS). Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Bland KI, Copeland EM, eds. 2010;45(3):650-654. breast augmentation with implant. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. What can I do if my insurance denies coverage for breast reduction? The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Major complications (1.6 %) included unilateral hematoma and localized infection. } Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). A population-level analysis of bilateral breast reduction: does age affect early complications? The primary outcome was the difference in wound drainage over 24 hours. Plast Reconstr Surg. Two review authors undertook independent data extraction of study characteristics, methodological quality and outcomes (e.g., infection, other wound complications, pain, and length of hospital stay [LOS]). Breast asymmetries: A brief review and our experience. Sugrue CM, McInerney N, Joyce CW, et al. This Clinical Policy Bulletin may be updated and therefore is subject to change. 1996;20(5):391-397. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Plast Reconstr Surg. Breast hypertrophy. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. Subjects were compared to age-matched norms from another study cohort. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Plast Reconstr Surg. They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. ul.ur li{ ASPS Recommended Coverage Criteria for Third Party Payors. The majority (87.7 %) of cases presented with accompanying mastalgia. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Plastic surgery for teenagers briefing paper. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Level of Evidence = IV. 2008;53(3):255-261. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Ann Plast Surg. } Am J Infect Control. Aetna considers breast reduction surgery medically necessary for non-cosmetic indications for women aged 18 or older or for whom growth is complete (i.e., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. .strikeThrough { 2012;130(4):785-789. The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Sabistons Textbook of Surgery (Burns & Blackwell, 2008)states that breast size should be stable for one year: There is no set lower age limit but, for the adolescent with breast hypertrophy, reduction is deferred until the breasts have stopped growing and are stable in size for at least 12 months before surgery.. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. Policy. list-style-type: lower-roman; Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Guidelines for Adolescent Health Care. Hoyos AE, Perez ME, Dominguez-Millan R, et al. 2000;106(2):280-288. Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. No new trials were identified for this first update. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. .newText { Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note 2017;139(6):1313-1322. Narula HS, Carlson HE. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. (25 y/o female with a 38J bra size) according to aetna, I should more than qualify for a reduction as I have back, neck, shoulder pain, chest pain and pressure, arm numbness while laying on sides, etc. Plast Reconstr Surg. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. World J Surg. color: blue list-style-type: decimal; Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. This may lead to additional scarring and additional operating time. Plast Reconstr Surg. Kerrigan CL, Collins ED, Kneeland TS, et al. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. For individuals who received radiation treatment to the chest . High-risk lesions (atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], and lobular carcinoma in situ [LCIS]) were revealed in 37 (11.7 %), and cancer in 6 (1.9 %) patients. Administration of Benefits and Transition Responsibilities A total of 15 articles met the inclusion criteria for review. 2001;108(6):1591-1599. Seitchik MW. Arlington Heights, IL: ASPS; May 2011. The mean age was 42.8 years (SD 19.5 years). Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Ann Plast Surg. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the skin should not be excised horizontally below the inframammary fold. In a review on Surgical treatment of primary gynecomastia in children and adolescents, Fischer et al (2014b) concluded that surgical correction of gynecomastia remains a purely elective intervention. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Risk of bias was assessed independently by 2review authors. }. Med Decis Making. padding: 10px; Schnur et al (1991) reported on a sliding scale assigns a weight of breast tissue to be removed based on body weight and surface area. A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammoplasty regarding physical symptoms and body image. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; J Plast Reconstr Aesthet Surg. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. In this study the National Surgical Quality Improvement Program data set was queried for the Current Procedural Terminology code 19318 from the years 2005 to 2010, with principal outcome measurements of wound complications, surgical site infections, and reoperations. Gynecomastia in patients with prostate cancer: A systematic review. Saunders Co.; 1991. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. ASPS clinical practice guideline summary on reduction mammaplasty. The risks included infection, wound breakdown, scarring, and the need for re-operating. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. CG-SURG-71 Reduction Mammaplasty - Anthem The study subjects were stratified into groups based on ages of <60 years and 60 years. Lonie S, Sachs R, Shen A, et al. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Policy Statement 6d: Aesthetic surgery procedures. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. Obesity and complications in breast reduction surgery: Are restrictions justified? Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. 2000;106(5):991-997. 01/04/2023 Khan SM, Smeulders MJ, Van der Horst CM. } The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. How to Get Your Breast Reduction Covered By Insurance - RealSelf News 1999;103(1):76-82; discussion 83-85. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. #closethis { OL OL OL LI { Ann Plast Surg. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia. Gynecomastia has been classified into2 types. text-decoration: line-through; This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Breast cancer found at the time of breast reduction. Breast reduction outcome study. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. color: red!important; Other just require 500 grams no matter what your height and weight. Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? Collis N, McGuiness CM, Batchelor AG. Autorino R, Perdona S, D'Armiento M, et al. 2005;55(3):227-231. Raispis T, Zehring RD, Downey DL. J Plast Surg Hand Surg. OL OL OL OL OL LI { An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Gland Surg. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Special Clinical Concerns. N Engl J Med. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Bertin ML, Crowe J, Gordon SM. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. color: red Statistical analysis was performed with student t-test and chi-square test. Handschin AE, Bietry D, Hsler R, et al. Breast reduction surgery - Mayo Clinic Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Socioeconomic Committee Position Paper. Burdette TE, Kerrigan CL, Homa KA. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. display: block; Chadbourne EB, Zhang S, Gordon MJ, et al. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. In these cases, breast reduction for men may take 2 to 3 hours. A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. Three review authors undertook independent screening of the search results. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. No data were provided on loss to follow-up. cursor: pointer; ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. PDF A look at new changes coming to E&M and breast coding in 2021 Breast Reduction | American Society of Plastic Surgeons A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. The authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). Second, it is the burden of the proponent of an intervention to provide reliable evidence of its effectiveness, not the burden of ones whoquestion the effectivenessan intervention to provide definitive proof of ineffectiveness. Does Health Insurance Cover Breast Reduction Surgery? - GoodRx Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. 2015;(10):CD007258. Abnormalities in Adolescent Breast Development. Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy. For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. Ages ranged from 18 to 66 years. .strikeThrough { This will be computed based on your body area. Glatt BS, Sarwer DB, O'Hara DE, et al. Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. The authors (Nguyen et al, 2004) argue, based primarily on the results of the ASPS-funded BRAVO study (described below), that (with a single exception) no objective criteria for breast reduction surgery are supportable, including criteria based upon the presence of particular signs or symptoms, requirements based upon breast size or the amount of breast tissue removed, any minimum age limitations, any limitation based upon maximum body weight, requirements for a trial of conservative therapy, or the exclusion of certain procedures (liposuction). 2020 Sep 4 [Online ahead of print]. Surg Laparosc Endosc Percutan Tech. 2021;147(5):1072-1083. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). color: blue!important; Tang CL, Brown MH, Levine R, et al. Oxfordshire NHS Trust. } A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. J Plast Reconstr Aesthet Surg. 2nd ed. J Plast Surg Hand Surg. A total of 182 thirty-day postoperative surgical complications were documented, but stratifying patients into 2 age groups did not reveal an association between age and any surgical complication (P = .26). Quality of life after breast reduction. And if you are in Canada the surgeon decides. bottom: 20px; The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02).
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