Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. OL OL LI { 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). Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Aesthetic Plast Surg. Little is known about the effect of surgical treatment on the psychological aspects of the disease. @media print { Study subjects included 3538 patients with an average age of 43 years and body mass index of 31.6 kg/m(2) and most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes.The incidence of overall surgical complications was 5.1% and the incidence of major surgical complications was 2.1%. } Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Reduction mammaplasty: An outcome study. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Ann Plast Surg. Kerrigan CL, Collins ED, Kneeland TS, et al. Reduction mammaplasty provides long-term improvement in health status and quality of life. Gonzalez FG, Walton RL, Shafer B, et al. Arlington Heights, IL: ASPS; March 9, 2002. cursor: pointer; The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. Ages ranged from 18 to 66 years. Aesthetic Plast Surg. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Araco A, Gravante G, Araco F, et al. If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. color: white; 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. } 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. 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. Arlington Heights, IL: ASPS; 2011. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. 2003;111(2):688-694. A physician-supervised diet and exercise plan may be indicated in obese patients. Note: Chronic intertrigo, eczema, dermatitis, and/or ulceration in the infra-mammary fold in and of themselves are not considered medically necessary indications for reduction mammoplasty. This Clinical Policy Bulletin may be updated and therefore is subject to change. 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. Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com Although the BRAVO study nominally included a "control group", there was no comparison group of subjects selected from the same cohort, who were randomized or otherwise appropriately assigned to reduce bias, and treated with conservative management according to a protocol to ensure optimal conservative care. Level of Evidence = IV. Surgical treatment of primary gynecomastia in children and adolescents. 1995;61(11):1001-1005. The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. 2014b;30(6):641-647. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. J Plast Reconstr Aesthet Surg. Gland Surg. color: #FFF; 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. } Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. 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. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Measuring health state preferences in women with breast hypertrophy. Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). 1. Burns JL, Blackwell SJ. Leclere FM, Spies M, Gohritz A, Vogt PM. Aetna considers breast reconstructive surgery to correct 1997;185(6):593-603. Br J Plast Surg. 2002;33:208-217. Sugrue CM, McInerney N, Joyce CW, et al. Fischer S, Hirsch T, Hirche C, et al. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. 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. 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.. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. A non-standardized survey showed a very high satisfaction index. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna My Experience of Having Breast Reduction Surgery - Health Plastic Reconstr Surg. right: 30px; }. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 2000;106(2):280-288. Ann Plastic Surg. 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. J Plast Surg Hand Surg. The author concluded that the current level of evidence on this subject was very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). 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). top: 0px; 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. The authors stated that operative subjects were told that their responses to the questionnaire were not to be used for insurance and thus the subjects had no motivation to exaggerate symptoms prior to surgery in questionnaire responses; however, it is not clear whether operative subjects would be willing to submit responses to a questionnaire from the doctor that differed substantially from the history that they provided to the doctor during their preoperative evaluation. Annu Rev Med. This investigators stated that these studies should include data from older individuals affected by gynecomastia and utilize valid tools of psychological measurement in order to better quantify the effect; elderly patients affected by the disease have been over-looked in the current research; more data on this subject could improve the pre-operative evaluation of these patients and help identify the patients who will benefit from treatment. Special Clinical Concerns. Subjects were compared to age-matched norms from another study cohort. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Breast Concerns of Adolescents. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 2008;61(5):493-502. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. OL OL OL LI { 1999;103(6):1687-1690. J Plast Surg Hand Surg. Arlington Heights, IL: ASPS; May 2011. Disproportionately large breasts can cause both physical and emotional . 2000;45(6):575-580. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. 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 Flancbaum L, Choban PS. Another set of breast pump supplies if you get pregnant . Pediatr Surg Int. Gynecomastia: Evolving paradigm of management and comparison of techniques. 1993;17(3):211-223. Evidence-based clinical practice guideline: Reduction mammaplasty. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. When seeking preauthorization for a breast reduction, your goal is generally twofold. 2010;45(3):650-654. 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. } Links to various non-Aetna sites are provided for your convenience only. 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. 2014a;34(3):409-416. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Aesthet Plastic Surg. Plast Reconstr Surg. Plast Reconstr Surg. 2018;7(Suppl 1):S70-S76. 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. Setala L, Papp A, Joukainen S, et al. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to 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. 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. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. } Plast Reconstr Surg. PLoS One. 2018;24(6):1043-1045. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Blomqvist L, Eriksson A, Brandberg Y. Laituri CA, Garey CL, Ostlie DJ, et al. Prostate Cancer Prostatic Dis. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Asian J Surg. Endocrinol Metab Clin North Am. This may lead to additional scarring and additional operating time. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Other just require 500 grams no matter what your height and weight. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. hr.separator { Plastic Reconstruct Surg. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. 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. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. This will be computed based on your body area. Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna The Breast: Comprehensive Management of Benign and Malignant Diseases. 1991;27(3):232-237. 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). There were 18 out of 415 studies eligible to review. In other patients, excess skin and nipple and areola relocation are necessary. 2005;55(3):227-231. Reduction mammoplasty: Criteria for insurance coverage. All the patients recovered well and were satisfied with the cosmetic outcomes. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note Reduction mammaplasty: Defining medical necessity. 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). 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. 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). position: fixed; American Society of Plastic and Reconstructive Surgery (ASPRS). Plast Reconstr Surg. These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? To get insurance coverage, you'll probably need . Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. 2008;53(3):255-261. 2017;139(6):1313-1322. Lonie S, Sachs R, Shen A, et al. OL OL OL OL OL LI { Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Kerrigan CL, Collins ED, Kim HM, et al. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. 2010;125(5):1301-1308. Plast Reconstr Surg. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Mistry RM, MacLennan SE, Hall-Findlay EJ. Breast J. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Howrigan P. Reduction and augmentation mammoplasty. GP Notebook. Prepubertal gynecomastia linked to lavender and tea tree oils. Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). PDF 0185 Breast Reconstructive Surgery (1) - Aetna 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: 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 Surgical management of gynecomastia--a 10-year analysis. 2001;108(1):62-67. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Because reduction mammoplasty may be used for both medically necessary and cosmetic indications, Aetna has set forth above objective criteria to distinguish medically necessary reduction mammoplasty from cosmetic reduction mammoplasty. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. .strikeThrough { 1998;101(2):361-364. You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. CG-SURG-71 Reduction Mammaplasty - Anthem Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Ann Plast Surg. Gynecomastia in patients with prostate cancer: Update on treatment options. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). The primary outcome was the difference in wound drainage over 24 hours. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 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. padding-bottom: 4px; } Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Townsend: Sabiston Textbook of Surgery. A detailed physical examination, including testicular examination. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. 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]. Also, there was no correlation between PR expression and 2D: 4D.