Narula HS, Carlson HE. font-size: 18px; Fagerlund A, Cormio L, Palangi L, et al. The authors reach the remarkable conclusion that a woman with normal sized breasts who has only a few ounces of breast tissue removed is as likely to receive as much benefit from breast reduction surgery as a women with large breasts who has substantially more breast tissue removed. # color: white; No necrosis, systemic infection, or muscle paralysis was reported. In the case of breast reduction, however, for insurance purposes, it . color: red!important; They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. The authors concluded that the limited evidence available showed no significant benefit of using post-operative wound drains in reduction mammoplasty, although LOS may be shorter when drains are not used. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or Plastic Reconstr 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. 18th ed. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. An 18-question survey was created evaluating various aspects of BBR practice; UK and Irish plastic and reconstructive and breast surgeons were invited to participate by an e-mail containing a link to a web-based survey. Aesthet Surg J. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. In a systematic review, these investigators examined the role of radiotherapy in this context. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). Nelson et al (2014b) separately conducted a population level analysis of the 2005-2011 NSQIP datasets, identifying patient who underwent reduction mammoplasty, to determine the impact of obesity on early complications after reduction mammoplasty. Breast J. PDF Summary of Proposed Aetna Medicare Advantage Agreement Exposure to partners using estrogen containing vaginal creams; Cancer chemotherapy (alkylating agents, methotrexate, vinca alkaloids, imatinib, combination chemotherapy), Androgen receptor blockers - bicalutamide, 5 reductase inhibitors - finasteride, dutasteride, Angiotensin converting enzyme inhibitors (captopril, enalapril), Calcium channelblockers(diltiazem, nifedipine, verapamil), Anabolic steroids(e.g., in body builders). The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. No new trials were identified for this first update. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. 1. No author listed. Grooving where the bra straps sit on the shoulder. PDF Procedures, programs and drugs you must precertify - AmeriBen 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., breast size stable over one year) when any of the following criteria (A, B, or C) is met: Macromastia: all of the following criteria must be met: Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. 2021;74(11):3128-3140. Treatment of adolescent gynecomastia. J Plast Surg Hand Surg. Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) Ann Plastic Surg. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Ann Plast Surg. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. American Society of Plastic Surgeons (ASPS). Reduction mammaplasty: An outcome study. Ann Plast Surg. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com The studies used to support the arguments for the medical necessity of breast reduction surgery are poorly controlled and therefore subject to a substantial risk of bias in the interpretation of results. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Women's Health and Cancer Rights Act of 1998. See Appendix for Table 1. 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". text-decoration: line-through; Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. padding-right: 18px; And if you are in Canada the surgeon decides. Washington, DC: ACOG; 2011:121-122. /*margin-bottom: 43px;*/ padding-bottom: 4px; 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. The mean age was 42.8 years (SD 19.5 years). 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. #backTop { Drainage in breast reduction surgery: A prospective randomised intra-patient trail. 1995;34(2):113-116. Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). color: blue Follow-up ranged from 2 months to 3 years. The primary outcome was the difference in wound drainage over 24 hours. Plastic surgery for teenagers briefing paper. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. li.bullet { Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Recommended criteria for insurance coverage of reduction mammoplasty. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Quality of life after breast reduction. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). Reduction mammoplasty for macromastia. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. list-style-type: upper-alpha; 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. Seitchik MW. Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. color: #FFF; Risk of bias was assessed independently by 2review authors. Breast J. Aesthet Plastic Surg. Fagerlund A, Lewin R, Rufolo G, et al. Aetna considers magnetic resonance imaging (MRI), with or without contrast materials, of the breast medically necessary for members who have had a recent (within the past year) conventional mammogram and/or breast sonogram, in any of the following circumstances where MRI of the breast may affect their clinical management:. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Copyright Aetna Inc. All rights reserved. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. top: 0px; In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Mayo Clin Proc. Brown MH, Weinberg M, Chong N, et al. 2014b;48(5):334-339. } Schnur PL, Schnur DP, Petty PM, et al. margin-top: 38px; Level of Evidence = IV. Reduction mammaplasty. You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. Yao Y, Yang Y, Liu J, et al. For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. 2014a;34(1):66-73. Breast asymmetries: A brief review and our experience. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Hello! Breast hypertrophy. Rising Rates of Insurance Denial for Breast Reduction Surgery It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. 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. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Socioeconomic Committee Position Paper. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. 1991;27(3):232-237. Risk factors for complications following breast reduction: Results from a randomized control trial. 2007;119(4):1159-1166. background-color: #cc0066; Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. background-position: right 65%; 1993;91(7):1270-1276. 2014;20(3):274-278. 2013;71(5):471-475. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. Aesthetic Plast Surg. Current concepts in gynaecomastia. A study by Bruhlmann and Tschopp (1998) was a retrospective study of 246 patients from a surgical practice, approximately 50 % (132) of whom returned a questionnaire about their symptoms and satisfaction with aesthetic results, and their recollection of symptoms prior to surgery. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. A non-standardized survey showed a very high satisfaction index. Plast Reconstr Surg. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). Marshall WA, Tanner JM. Gonzalez FG, Walton RL, Shafer B, et al. 2009;62(2):195-199. 1997;100(4):875-883. width: 100%; The authors concluded that breast re-reduction can be performed safely and predictably, even when the previous technique is not known; and 4 key principles were developed: Language services can be provided by calling the number on your member ID card. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Ann Plast Surg. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Abnormal histopathological findings were more frequent in patients with reduction mammoplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). An average of 320 specimens were excised from each side with mean blood loss of 34 ml. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Glatt BS, Sarwer DB, O'Hara DE, et al. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? border-radius: 4px; The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. # font-weight: bold; Reduction mammaplasty: A review of managed care medical policy coverage criteria. 1993;17(3):211-223. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline 2006;9(2):109-114. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). 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. The majority (87.7 %) of cases presented with accompanying mastalgia. 40 . }. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. For medical Breast. 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. Setala L, Papp A, Joukainen S, et al. Level of Evidence = IV. Anesthesia may be injected along with saline solution until the tissue is firm, and a suction cannula is used to extract fat from the breast. Aesthetic Plast Surg. Pediatr Surg Int. A cohort study of breast cancer risk in breast reduction patients. In these cases, breast reduction for men may take 2 to 3 hours. These preliminary findings need to be validated by well-designed studies. 2015;49(6):311-318. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. 1999;103(6):1674-1681. 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. .strikeThrough { display: block; The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. J Pediatr Surg. Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. list-style-type: lower-alpha; 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). 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. How to make Aetna pay for your breast reduction surgery Gynecomastia in patients with prostate cancer: A systematic review. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Arlington Heights, IL: ASPS; March 9, 2002. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2).
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