The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 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. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Disproportionately large breasts can cause both physical and emotional . Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Well-designed clinical trials provide reliable information about the effectiveness of an intervention, and provide valid information about the characteristics of patients who would benefit from that intervention. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Breast Reduction Surgery | Johns Hopkins Medicine The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. 2021 Aug 11 [Online ahead of print]. Plast Reconstr Surg. The health burden of breast hypertrophy. 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. In the case of breast reduction, however, for insurance purposes, it . 2009;7(2):114-119. The study subjects were stratified into groups based on ages of <60 years and 60 years. Chadbourne EB, Zhang S, Gordon MJ, et al. list-style-type: decimal; Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Blomqvist L, Eriksson A, Brandberg Y. Plast Reconstr Surg. Computed tomography scan of adrenal glands to identify adrenal lesions. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. 1995;61(11):1001-1005. 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. And if you are in Canada the surgeon decides. Rising Rates of Insurance Denial for Breast Reduction Surgery Breast reduction surgery - Mayo Clinic Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). A total of 90 patients underwent breast re-reduction surgery. J Plast Reconstr Aesthet Surg. Burdette TE, Kerrigan CL, Homa KA. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Evidence-based clinical practice guideline: Reduction mammaplasty. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. 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). 2013;71(5):471-475. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Abnormalities in Adolescent Breast Development. Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . Aesthetic Plast Surg. 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. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. 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. Many men with breast enlargement are found to have pseudo-gynecomastia. 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. 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. What are Aetna breast reduction requirements? - RealSelf.com Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. Gland Surg. The member has gigantomastia of pregnancy accompanied byany of the following complications, and delivery is not imminent: For medical necessity criteria for surgery to correct breast asymmetry, seeCPB 0185 - Breast Reconstructive Surgery. #backTop { } 2004;113(1):436-437. My Experience of Having Breast Reduction Surgery - Health Mental health care professionals may be consulted to address psychological distress from gynecomastia. 2015;10(8):e0136094. 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. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Schnur PL, Hoehn JG, Ilstrup DM, et al. Raispis T, Zehring RD, Downey DL. Saunders Co.; 1991. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Obesity and complications in breast reduction surgery: Are restrictions justified? Subjects were compared to age-matched norms from another study cohort. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Breast J. A physician-supervised diet and exercise plan may be indicated in obese patients. 1995;95(1):77-83. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. } Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) Measuring health state preferences in women with breast hypertrophy. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Breast pumps. Aetna considers breast reconstructive surgery to correct 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 . 18th ed. Breast Concerns of Adolescents. 2014a;34(3):409-416. 1996;20(5):391-397. } They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. Risk of bias was assessed independently by 2review authors. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. 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). 2021;74(11):3128-3140. This conclusion is based primarily upon the Breast Reduction Assessment of Value and Outcomes (BRAVO) study, which is described in several articles (Kerrigan et al, 2001; Kerrigan et al, 2002; Collins et al, 2002). Thus, more than 1/3of operative subjects selected for inclusion in the study did not complete it; most of the operative subjects who did not complete the study were lost to follow-up. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. This Clinical Policy Bulletin may be updated and therefore is subject to change. A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio). The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . Howrigan P. Reduction and augmentation mammoplasty. 1999;103(1):76-82; discussion 83-85. 40 . border-radius: 4px; Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Plast Reconstr Surg. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Asian J Surg. 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. Plast Reconstr Surg. } 1995;34(2):113-116. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Magnetic Resonance Imaging (MRI) of the Breast - Aetna 2000;44(2):125-134. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Washington, DC: ACOG; 2011:121-122. color: blue!important; Breast and aesthetic surgery. The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. Ages ranged from 18 to 66 years. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. 2007;119(4):1159-1166. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). Plast Reconstr Surg. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . See Appendix for Table 1. 1998;41(3):240-245. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). 2018;89(6):408-412. text-decoration: line-through; Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). Kerrigan CL, Collins ED, Kneeland TS, et al. The Mammotome procedure represented another novel therapeutic option for gynecomastia. color:#eee; Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. 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). Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. border-width:0; OL OL OL LI { outline: none; 2018;7(Suppl 1):S70-S76. 2000;106(2):280-288. 2007;36(2):497-519. 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. Plastic Reconstruct Surg. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. .headerBar { 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. A total of 81 patients were included in this study. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. 1997;185(6):593-603. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline Mizgala CL, MacKenzie KM. Reduction mammoplasty: Criteria for insurance coverage. In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. All the patients recovered well and were satisfied with the cosmetic outcomes. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Setala L, Papp A, Joukainen S, et al. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note OL OL OL OL OL LI { display: none; Gynecomastia is a very common concern of male adolescence. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Administration of Benefits and Transition Responsibilities Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. No data were provided on loss to follow-up. Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna The Breast: Comprehensive Management of Benign and Malignant Diseases. Sugrue CM, McInerney N, Joyce CW, et al. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Collins ED, Kerrigan CL, Kim M, et al. Ann Plastic Surg. Prepubertal gynecomastia linked to lavender and tea tree oils. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . @media print { 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. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Breast. Level of Evidence = III. 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]). Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 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. bottom: 20px; Ann Plast Surg. 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. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. right: 30px; 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. Surgical implications of obesity. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Reduction mammaplasty provides long-term improvement in health status and quality of life. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Resolution of idiopathic gynecomastia may take several months to years. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Major complications (1.6 %) included unilateral hematoma and localized infection. Gynecomastia: Evolving paradigm of management and comparison of techniques. Plast Reconstr Surg. Surgery. Wound drainage after plastic and reconstructive surgery of the breast. 2009;62(2):195-199. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. } 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. Obstet Gynecol Clin North Am. 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). Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. color: blue Bland KI, Copeland EM, eds. The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. 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 }. While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. 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). PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna .newText { } 2nd ed. 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. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. The end-point was the complete resolution of gynecomastia. of the following criteria must be met: Gynecomastia: A systematic review. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Quality of life after breast reduction. Surgical treatment of primary gynecomastia in children and adolescents. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. 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:. Reduction mammaplasty: An outcome study. Please check your insurance policy to see whether breast reduction is a covered procedure. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Ann Plast Surg. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. Gynecomastia has been classified into2 types. Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. 2006;9(2):109-114. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna display: block; If an insufficient amount of breast tissue is removed, the surgery is less likely to be successful in relieving pain and any related symptoms from excessive breast weight (e.g., excoriations, rash). Determinants of surgical site infection after breast surgery. Aesthet Surg J. Plast Reconstr Surg. Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Li CC, Fu JP, Chang SC, et al. 2008;32(1):38-44. A systematic search of the published literature was performed. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Autorino R, Perdona S, D'Armiento M, et al. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. J Pediatr Surg. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Gynecomastia in patients with prostate cancer: A systematic review. 2014b;48(5):334-339. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. --> Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. PDF 0185 Breast Reconstructive Surgery (1) - Aetna In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Reduction mammoplasty: Cosmetic or reconstructive procedure? How to make Aetna pay for your breast reduction surgery .newText { Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. 2002;109(5):1556-1566. position: fixed; 2 . 2014a;34(1):66-73. No necrosis, systemic infection, or muscle paralysis was reported. Krieger LM, Lesavoy MA. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. color: red 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.
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