These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %).
Is breast reduction covered by health insurance? | ASPS Last Review01/04/2023. Ann Plast Surg. 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. Reduction mammaplasty. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. display: block; 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. 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. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. 2000;106(5):991-997. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. The following procedures are considered experimental and investigational because there is insufficient evidence of itseffectiveness or itseffectiveness has not been established: Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. J Plast Reconstr Aesthet Surg. color:#eee; Breast reduction for symptomatic macromastia. 2001;108(6):1591-1599. }
Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Pediatr Surg Int. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. } Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. OL OL LI { 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. Devalia HL, Layer GT. 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%. Follow-up ranged from 2 months to 3 years. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Aesthet Surg J. 2018;7(Suppl 1):S70-S76. 2014b;30(6):641-647.
My Experience of Having Breast Reduction Surgery - Health background: #5e9732; However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. The average age was 24.7 years (range of 18 to 47 years).
PDF Procedures, programs and drugs you must precertify - AmeriBen It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. 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. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. 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. American Society of Plastic Surgeons (ASPS). Arch Dis Child. Am Surg. Plastic surgery for teenagers briefing paper. Management of gestational gigantomastia. 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. Hello! Administration of Benefits and Transition Responsibilities J Plast Reconstr Aesthet Surg. Reduction mammoplasty improves symptoms of macromastia.
PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna In the case of breast reduction, however, for insurance purposes, it . With approval from the authors institutional ethics committee and written informed consent, a total of 22 patients with 33 abnormally hyperplastic breasts were enrolled at the First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. 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. Handschin AE, Bietry D, Hsler R, et al. Surgery. The Mammotome procedure represented another novel therapeutic option for gynecomastia. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Burdette TE, Kerrigan CL, Homa KA. list-style-type: decimal; Subjects were compared to age-matched norms from another study cohort. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Br J Plast Surg. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. Reduction mammoplasty for asymptomatic members is considered cosmetic. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. Plast Reconstr Surg. } Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Prostate Cancer Prostatic Dis. 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). All studies on the subject were evaluated for inclusion and 6 studies were included in the review. 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]. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. /*margin-bottom: 43px;*/ 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.
PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com A systematic search of the published literature was performed. Breast. Many men with breast enlargement are found to have pseudo-gynecomastia. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Ann Plast Surg. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Coding The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Reduction mammaplasty: A review of managed care medical policy coverage criteria. bottom: 20px; The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Ann Plastic Surg. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. 2009;7(2):114-119. Krieger LM, Lesavoy MA. 2015;75(4):370-375. Endocrinol Metab Clin North Am. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including.
Does Aetna Cover Breast Reduction? | HelpAdvisor.com There were no restrictions on the basis of date or language of publication. The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. position: fixed; Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. 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. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Please check your insurance policy to see whether breast reduction is a covered procedure. Plast Reconstr Surg. The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. Plast Reconstr Surg. hr.separator { 2009;62(2):195-199. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. of . color: red Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years).
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. Breast asymmetries: A brief review and our experience. Brown DM, Young VL. 1991;27(3):232-237. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Another set of breast pump supplies if you get pregnant . Special Clinical Concerns. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Plast Reconstr Surg. A total of 244 out of 1,628 patients with the average age of 23.13 years. Computed tomography scan of adrenal glands to identify adrenal lesions. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Type II gynecomastia is more generalized breast enlargement. Ann Plast Surg. 2007;356(5):479-485. J Plast Surg Hand Surg. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Wound drainage after plastic and reconstructive surgery of the breast. American Society of Plastic Surgeons (ASPS). Level of Evidence = IV. 1999;103(6):1687-1690. All RCTs that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Gynecomastia: A systematic review. 2006;118(4):840-848. Ann Chir Plast Esthet. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. top: 0px; Asian J Surg. 2008;53(3):255-261. Khan SM, Smeulders MJ, Van der Horst CM. These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. Aesthet Surg J. Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Aesthet Plastic 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]). A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. OL LI { Kalliainen LK; ASPS Health Policy Committee. 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. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Oxford, UK: National Health Service (NHS); October 2008. 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. 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.
Breast Reduction Surgery | Johns Hopkins Medicine These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Statistical analysis was performed with student t-test and chi-square test. Also, there was no correlation between PR expression and 2D: 4D. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. 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 augmentation with implant. Policy. 1990;24(1):61-67. 2015;10(8):e0136094. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. 2020 Sep 4 [Online ahead of print]. 2016;20(3):256-260. Surgical treatment of primary gynecomastia in children and adolescents. Mizgala CL, MacKenzie KM. 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. width: 100%; Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. Plastic Reconstruct Surg. Breast pumps. 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. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Tang CL, Brown MH, Levine R, et al. 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. ASPS Recommended Coverage Criteria for Third Party Payors. 2019;166(5):934-939. Gynecomastia has been classified into2 types. Brown MH, Weinberg M, Chong N, et al. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). 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. 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). Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. 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. 2006;9(2):109-114. Breast reduction outcome study. Patient demographics, surgical technique, and outcomes were analyzed. } } No necrosis, systemic infection, or muscle paralysis was reported. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. } 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. Burns JL, Blackwell SJ. In the case of reduction mammoplasty for relief of back, neck and shoulder pain, Aetna has considered this procedure medically necessary in women with excessively large breasts because it seems logical, even in the absence of firm clinical trial evidence, that this excessive weight would contribute to back and shoulder pain, and that removal of this excessive breast tissue would provide substantial pain relief, reductions in disability, and improvements in function. Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. 2001;108(1):62-67. 2008;32(1):38-44.
Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Furthermore, the lack of an expected "dose-response" relationship between the amount of breast tissue removed and the magnitude of symptomatic relief in these studies raises questions about the validity of these studies and the effectiveness of breast reduction as a method of relieving shoulder and back pain. In: Townsend CM, Beuchamp RD, Evers BM, eds. Surgeon. 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. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. right: 30px; 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. 2nd ed. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Philadelphia, PA: W.B. Breast cancer found at the time of breast reduction. Prepubertal gynecomastia linked to lavender and tea tree oils. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. 2015;(10):CD007258. Aesthetic Plast Surg. American Society of Plastic and Reconstructive Surgery (ASPRS). The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. 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. A cohort study of breast cancer risk in breast reduction patients. 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 mammaplasty: Defining medical necessity. And if you are in Canada the surgeon decides. 2015;75(4):383-387. 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". Ann Plast Surg. 2021 Aug 11 [Online ahead of print]. The authorsleave the reader with the conclusionthat decisions about the medical necessity of breast reduction surgery in symptomatic women should be left entirely to the surgeon's discretion. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. In these cases, breast reduction for men may take 2 to 3 hours. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Mayo Clin Proc. 1993;91(7):1270-1276. To get insurance coverage, you'll probably need . 2002;33:208-217. 2008;121(4):1092-1100. Howrigan P. Reduction and augmentation mammoplasty. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Leclere FM, Spies M, Gohritz A, Vogt PM. list-style-type: lower-alpha; Reduction mammoplasty: Criteria for insurance coverage. Surgical treatment of gynecomastia: Complications and outcomes. Washington, DC: ACOG; 2011:121-122. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary.