The nipple-areola complex was re-positioned in 60 % of patients (n = 54). cursor: pointer; Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. 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. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). In a systematic review, these investigators examined the role of radiotherapy in this context. Philadelphia, PA: W.B. Variations in pattern of pubertal changes in girls. Women's Health and Cancer Rights Act of 1998. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Aesthetic Plast Surg. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. 1998;101(2):361-364. } Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. 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. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. 2010;45(3):650-654. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. 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. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. .newText { Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. /* aetna.com standards styles for templates */ Gynecomastia in patients with prostate cancer: A systematic review. 01/04/2023 Plast Reconstr Surg. 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. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. 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. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare 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". Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Plast Reconstr Surg. Plastic surgery for teenagers briefing paper. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. 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). The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Three review authors undertook independent screening of the search results. Aesthetic Plast Surg. Determinants of surgical site infection after breast surgery. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 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. 2014a;34(3):409-416. Measuring health state preferences in women with breast hypertrophy. Breast Reduction Surgery | Johns Hopkins Medicine Gynecomastia: Evolving paradigm of management and comparison of techniques. 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. 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. Magnetic Resonance Imaging (MRI) of the Breast - Aetna Reduction mammaplasty: Defining medical necessity. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Please check your insurance policy to see whether breast reduction is a covered procedure. text-decoration: underline; They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Reduction mammoplasty: Criteria for insurance coverage. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. 1995;61(11):1001-1005. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. outline: none; 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). While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. The member has gigantomastia of pregnancy accompanied byany of the following complications, and delivery is not imminent: For medical necessity criteria for surgery to correct breast asymmetry, seeCPB 0185 - Breast Reconstructive Surgery. Macromastia: all . Another set of breast pump supplies if you get pregnant . If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Schnur PL, Schnur DP, Petty PM, et al. Emiroglu M, Salimoglu S, Karaali C, et al. Kerrigan CL, Collins ED, Striplin D, et al. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Prostate Cancer Prostatic Dis. 2015;10(8):e0136094. American Society of Plastic Surgeons (ASPS). Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Marshall WA, Tanner JM. Plast Reconstr Surg. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. 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 There were only 2 studies of a total 25 patients that were considered as good in quality. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. 2007;119(4):1159-1166. 2nd ed. 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. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 1993;17(3):211-223. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 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. .headerBar { Am Surg. Kasielska-Trojan A, Danilewicz M, Antoszewski B. A follow-up study of 105 women with breast cancer following reduction mammaplasty. OL LI { 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. background-color: #cc0066; Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. A non-standardized survey showed a very high satisfaction index. } If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. 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). Breast and aesthetic surgery. skin should not be excised horizontally below the inframammary fold. Copyright Aetna Inc. All rights reserved. To get insurance coverage, you'll probably need . Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. hr.separator { 2001;108(1):62-67. J Am Coll Surg. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. 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: color:#eee; Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. For medical Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Plast Reconstr Surg. Plast Reconstr Surg. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. In other patients, excess skin and nipple and areola relocation are necessary. Schnur et al (1991) reported on a sliding scale assigns a weight of breast tissue to be removed based on body weight and surface area. Ann Plast Surg. 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). padding-bottom: 4px; Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Gland Surg. For many patients the psychological impact of the disease is substantial. Gynecomastia: A systematic review. Bland KI, Copeland EM, eds. 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. Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. 2009;7(2):114-119. of the following criteria must be met: 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. 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. Washington, DC: ACOG; 2011:121-122. 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. PDF Procedures, programs and drugs you must precertify - AmeriBen Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. 1990;24(1):61-67. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Ann Plast Surg. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note } 2014;20(3):274-278. 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). 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. .strikeThrough { Plast Reconstr Surg. 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. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Ann Chir Plast Esthet. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. }. Surgical treatment of primary gynecomastia in children and adolescents. 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. Reduction mammoplasty for asymptomatic members is considered cosmetic. Plast Reconstr Surg. The majority (87.7 %) of cases presented with accompanying mastalgia. 2015;75(4):383-387. 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. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com A total of 81 patients were included in this study. 1969;44(235):291-303. 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]). 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. 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. Collis N, McGuiness CM, Batchelor AG. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. 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. 1998;49:215-234. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. color: #FFF; Petty PM, Solomon M, Buchel EW, Tran NV. 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. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). The mean volume of tissue resected was 250 g (range of 22 to 758 g) from the right breast and 244 g (range of 15 to 705 g) from the left breast. Plast Reconstr Surg. margin-bottom: 38px; 2008;121(4):1092-1100. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). 1995;95(6):1029-1032. The study subjects were stratified into groups based on ages of <60 years and 60 years. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Subjects were compared to age-matched norms from another study cohort. 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. Gonzalez FG, Walton RL, Shafer B, et al. A total of 90 patients underwent breast re-reduction surgery. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. border-width:0; Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). 1. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. PDF Gender Dysphoria Treatment - Cigna Does Aetna Cover Breast Reduction? | HelpAdvisor.com Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. 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 . 2005;58(3):286-289. 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). 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. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Arlington Heights, IL: ASPS; March 9, 2002. Setala L, Papp A, Joukainen S, et al. height:2px; CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the 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. Prepubertal gynecomastia linked to lavender and tea tree oils. 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. 1991;27(3):232-237. Also, there was no correlation between PR expression and 2D: 4D. 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. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. 2018;7(Suppl 1):S70-S76. Plast Reconstr Surg. Surgical implications of obesity. 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.
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