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]). American Society of Plastic Surgeons (ASPS).
Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna 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]. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. list-style-type: upper-roman; Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Plast 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. Chadbourne EB, Zhang S, Gordon MJ, et al. Measuring health state preferences in women with breast hypertrophy. Links to various non-Aetna sites are provided for your convenience only. Narula HS, Carlson HE. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. 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). Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Level of Evidence = IV. 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. 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. The end-point was the complete resolution of gynecomastia.
Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare 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 . 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. Current concepts in gynaecomastia. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Hoyos AE, Perez ME, Dominguez-Millan R, et al. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Raispis T, Zehring RD, Downey DL. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. 2008;121(4):1092-1100. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. 2014a;34(1):66-73. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). list-style-type: lower-alpha; 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. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Also, there was no correlation between PR expression and 2D: 4D. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. 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. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients.
Magnetic Resonance Imaging (MRI) of the Breast - Aetna 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. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Devalia HL, Layer GT. } Determinants of surgical site infection after breast surgery. Howrigan P. Reduction and augmentation mammoplasty. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Copyright Aetna Inc. All rights reserved. Fagerlund A, Cormio L, Palangi L, et al. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. of . 2003;111(2):688-694. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. This may lead to additional scarring and additional operating time. Wound drainage after plastic and reconstructive surgery of the breast. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. } Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. No new trials were identified for this first update. Plastic Reconstruct Surg. Li CC, Fu JP, Chang SC, et al. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. 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. 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. They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. J Plast Surg Hand Surg. #closethis { Breast asymmetries: A brief review and our experience. Priorities Forum Policy Statement. Reduction mammaplasty: The need for prospective randomized studies. Reduction mammoplasty improves symptoms of macromastia. Handschin AE, Bietry D, Hsler R, et al. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Townsend: Sabiston Textbook of Surgery. bottom: 20px;
Breast reduction surgery - Mayo Clinic Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. 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. 2015;75(4):383-387. background-color:#eee; Philadelphia, PA: W.B. Br J Plast Surg. ol.numberedList LI { Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Policy. 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. However, these medications should be reserved for those with no decrease in breast size after 2 years. 2014b;48(5):334-339. 2007;36(2):497-519. Ann Plast Surg. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. In these cases, breast reduction for men may take 2 to 3 hours. There were only 2 studies of a total 25 patients that were considered as good in quality. 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. Am J Infect Control. 2005;55(3):227-231. Breast J. 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. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. 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. See Appendix for Table 1. padding: 10px; Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. 2014a;34(3):409-416. Analysis was on an intention-to-treat basis. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. 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: list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important;
PDF Procedures, programs and drugs you must precertify - AmeriBen 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). Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Setala L, Papp A, Joukainen S, et al.
How to Get Your Breast Reduction Covered By Insurance - RealSelf News A detailed physical examination, including testicular examination. 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). } color: red Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. J Plast Reconstr Aesthet Surg. Management of gestational gigantomastia. Cochrane Database Syst Rev. Computed tomography scan of adrenal glands to identify adrenal lesions. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. 2000;45(6):575-580. All the patients recovered well and were satisfied with the cosmetic outcomes. Gland Surg. 2005;58(3):286-289. To get insurance coverage, you'll probably need . #backTop { As explained below, 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. 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. Abnormalities in Adolescent Breast Development. 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. Schnur PL, Schnur DP, Petty PM, et al. 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. 2019;166(5):934-939. Emiroglu M, Salimoglu S, Karaali C, et al. #backTop:hover { Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Yao Y, Yang Y, Liu J, et al. 1995;95(1):77-83. 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. Reduction mammaplasty provides long-term improvement in health status and quality of life. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. 1999;103(6):1682-1686. Ann Plastic Surg. 2007;356(5):479-485. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. 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. color: blue!important; Tang CL, Brown MH, Levine R, et al. Aesthetic Plast Surg. 2002;33:208-217. 2018;7(Suppl 1):S70-S76. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Statistical analysis was performed with student t-test and chi-square test. Miller AP, Zacher JB, Berggren RB, et al. Seitchik MW. Level of Evidence = IV. With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an out-patient; however, this was not statistically significant (p = 0.07). Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Grooving where the bra straps sit on the shoulder. Gynecomastia in patients with prostate cancer: A systematic review. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. --> Marshall WA, Tanner JM. }.
Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. 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. Washington, DC: ACOG; 2011:121-122. Ann Plast 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. Surgeon. Kasielska-Trojan A, Danilewicz M, Antoszewski B. 2000;44(2):125-134. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. text-decoration: line-through; } 2008;32(1):38-44. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Bland KI, Copeland EM, eds. width: 100%; Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. J Plast Reconstr Aesthet Surg. Horm Res Paediatr. Plast Reconstr Surg. 1996;20(5):391-397. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. 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. } If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Gynecomastia in patients with prostate cancer: Update on treatment options. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion.
What are Aetna breast reduction requirements? - RealSelf.com hr.separator { Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Patients with abnormal histopathology could not be pre-operatively identified based on demographics.
Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. 2007;119(4):1159-1166. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. The mean age was 42.8 years (SD 19.5 years). Plastic Reconstr Surg. Aesthet Plastic Surg. 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. .strikeThrough { list-style-type: lower-roman; They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Patient demographics, surgical technique, and outcomes were analyzed. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Arlington Heights, IL: ASPS; 2011. The primary outcome was the difference in wound drainage over 24 hours. Treating providers are solely responsible for medical advice and treatment of members. 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). 2001;76(5):503-510. Sood R, Mount DL, Coleman JJ 3rd, et al. } 1995;95(6):1029-1032. Plastic Reconstr Surg. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. 1995;61(11):1001-1005. background-color: #663399; Surgical treatment is indicated when medical treatments fail. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Principles of breast re-reduction: A reappraisal.
Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com Recommended criteria for insurance coverage of reduction mammoplasty. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. OL OL OL LI { The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. 2015;(10):CD007258.