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Women's Health and Cancer Rights Act of 1998. Priorities Forum Policy Statement. 2010;125(5):1301-1308. 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. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Plastic Reconstr Surg. 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. No new trials were identified for this first update. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. 2014a;34(1):66-73. This will be computed based on your body area. 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. } Principles of breast re-reduction: A reappraisal. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. 2009;62(2):195-199. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. Plast Reconstr Surg. OL OL LI { There were 18 out of 415 studies eligible to review. Kerrigan CL, Collins ED, Striplin D, et al. For individuals who received radiation treatment to the chest . And if you are in Canada the surgeon decides. Aesthet Surg J. 2000;106(5):991-997. Surg Laparosc Endosc Percutan Tech. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). 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: position: fixed; 2001;76(5):503-510. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Mizgala CL, MacKenzie KM. Policy. 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. list-style-type: lower-roman; This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review Last Review01/04/2023. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. The Breast: Comprehensive Management of Benign and Malignant Diseases. 2012;130(4):785-789. 2014;20(3):274-278. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. For many patients the psychological impact of the disease is substantial. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). Brown MH, Weinberg M, Chong N, et al. Is breast reduction covered by health insurance? | ASPS Analysis was on an intention-to-treat basis. } Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Breast hypertrophy. Plastic Reconstruct Surg. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. 2006;9(2):109-114. 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.. color:#eee; Aesthet Surg J. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. 2017;35:157-161. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. 2015;49(6):311-318. .newText { Breast and aesthetic surgery. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. There were only 2 studies of a total 25 patients that were considered as good in quality. 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). Collis N, McGuiness CM, Batchelor AG. A physician-supervised diet and exercise plan may be indicated in obese patients. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Collins ED, Kerrigan CL, Kim M, et al. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Wound drainage after plastic and reconstructive surgery of the breast. Does Aetna Cover Breast Reduction? | HelpAdvisor.com Gynecomastia in patients with prostate cancer: Update on treatment options. Glatt BS, Sarwer DB, O'Hara DE, et al. background: #5e9732; These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Ages ranged from 18 to 66 years. 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%. of . Ann Plast Surg. display: none; Grooving where the bra straps sit on the shoulder. Endocrinol Metab Clin North Am. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. 2017;139(6):1313-1322. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Prepubertal gynecomastia linked to lavender and tea tree oils. of the following criteria must be met: Management of gestational gigantomastia. Arlington Heights, IL: ASPS; May 2011. 2015;75(4):370-375. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. 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. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. What are Aetna breast reduction requirements? - RealSelf.com J Laparoendosc Adv Surg Tech A. Plast Reconstr Surg. 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: 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). Blomqvist L, Eriksson A, Brandberg Y. When seeking preauthorization for a breast reduction, your goal is generally twofold. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Reduction mammaplasty: The need for prospective randomized studies. Refer to the member's specific plan document for applicable coverage. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. 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. American Society of Plastic Surgeons (ASPS). Magnetic Resonance Imaging (MRI) of the Breast - Aetna Operative subjects who completed the study reported reductions in pain and improvements in quality of life; however, these improvements may be attributable to placebo effects, the natural history of back pain, other concurrent interventions, regression to the mean, improvements in cosmesis (for quality of life measures), or other confounding variables that may bias in interpretation of results. Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). Lonie S, Sachs R, Shen A, et al. Li CC, Fu JP, Chang SC, et al. 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). Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. 2000;44(2):125-134. Aesthetic Plast Surg. 1996;20(5):391-397. 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. The study subjects were stratified into groups based on ages of <60 years and 60 years. Type II gynecomastia is more generalized breast enlargement. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Copyright Aetna Inc. All rights reserved. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Fischer S, Hirsch T, Hirche C, et al. } Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Ann Plast Surg. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Measuring health state preferences in women with breast hypertrophy. }. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. 1998;26(1):61-65. This may lead to additional scarring and additional operating time. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne list-style-type: decimal; Other just require 500 grams no matter what your height and weight. Level of Evidence = IV. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Breast reduction for symptomatic macromastia. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. N Engl J Med. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. 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. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. color: #FFF; Chadbourne EB, Zhang S, Gordon MJ, et al. Reduction mammoplasty improves symptoms of macromastia. 2014a;34(3):409-416. Statistical analysis was performed with student t-test and chi-square test. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. #backTop { Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. 2 . However, these medications should be reserved for those with no decrease in breast size after 2 years. Variations in pattern of pubertal changes in girls. In a systematic review, these investigators examined the role of radiotherapy in this context. A total of 244 out of 1,628 patients with the average age of 23.13 years. Aesthetic Plast Surg. J Plast Surg Hand Surg. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammoplasty regarding physical symptoms and body image. 1969;44(235):291-303. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Plast Reconstr Surg. Long-term functional results after reduction mammoplasty. outline: none; Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. 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. 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. The primary outcome was the difference in wound drainage over 24 hours. A cohort study of breast cancer risk in breast reduction patients. Gynecomastia is a very common concern of male adolescence. 2005;58(3):286-289. Marshall WA, Tanner JM. Does Health Insurance Cover Breast Reduction Surgery? - GoodRx Laituri CA, Garey CL, Ostlie DJ, et al. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Often times, insurance company will dictate how much breast tissue to be removed. Reduction mammoplasty for asymptomatic members is considered cosmetic. 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). 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 . Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Breast pumps. 2018;7(Suppl 1):S70-S76. Philadelphia, PA: W.B. ASPS Recommended Coverage Criteria for Third Party Payors. 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. In these cases, breast reduction for men may take 2 to 3 hours. Sood R, Mount DL, Coleman JJ 3rd, et al. list-style-type: upper-alpha; They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. 1997;185(6):593-603. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). 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. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Arlington Heights, IL: ASPRS; 1987. Breast. padding: 15px; Plast Reconstr Surg. J Am Coll Surg. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. The health burden of breast hypertrophy. PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna 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. } Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). } Philadelphia, PA: WB Saunders Company; 2008; Ch 73. 2nd ed. PDF Procedures, programs and drugs you must precertify - AmeriBen Plastic Reconstr Surg. J Plast Surg Hand Surg. 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. Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. Ann Plast Surg. Coding 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. A follow-up study of 105 women with breast cancer following reduction mammaplasty. 2007;36(2):497-519. 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. 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. padding-bottom: 4px; 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. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Plast Reconstr Surg. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Asian J Surg. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. 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.