Narula HS, Carlson HE. 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. A physician-supervised diet and exercise plan may be indicated in obese patients. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Sood R, Mount DL, Coleman JJ 3rd, et al. Oxfordshire NHS Trust. 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). 2020 Sep 4 [Online ahead of print]. margin-bottom: 38px; Ann Plast Surg. For individuals who received radiation treatment to the chest . 2000;106(2):280-288. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. To get insurance coverage, you'll probably need . Mistry RM, MacLennan SE, Hall-Findlay EJ. 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. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Macromastia: all . 2016;20(3):256-260. In these cases, breast reduction for men may take 2 to 3 hours. Determinants of surgical site infection after breast surgery. 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. A population-level analysis of bilateral breast reduction: does age affect early complications? /*margin-bottom: 43px;*/ The majority (87.7 %) of cases presented with accompanying mastalgia. There were only 2 studies of a total 25 patients that were considered as good in quality. top: 0px; Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. OL OL OL OL OL LI { Aesthet Plastic Surg. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain.
Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. color: blue A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio). Cochrane Database Syst Rev. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Treatment of adolescent gynecomastia. Plastic Reconstruct Surg. In a systematic review, these investigators examined the role of radiotherapy in this context. Guidelines for Adolescent Health Care. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. Although the BRAVO study nominally included a "control group", there was no comparison group of subjects selected from the same cohort, who were randomized or otherwise appropriately assigned to reduce bias, and treated with conservative management according to a protocol to ensure optimal conservative care.
PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Grooving where the bra straps sit on the shoulder. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Breast J. Level of Evidence = IV. Follow-up ranged from 2 months to 3 years.
Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note color:#eee; Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. In other patients, excess skin and nipple and areola relocation are necessary.
What can I do if my insurance denies coverage for breast reduction? Nguyen JT, Wheatley MJ, Schnur PL, et al. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. 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). 1998;101(2):361-364. } Variations in pattern of pubertal changes in girls. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Kerrigan CL, Collins ED, Kneeland TS, et al. Blomqvist L, Eriksson A, Brandberg Y. 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). Abnormal histopathological findings were more frequent in patients with reduction mammoplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). 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: .arrowPurpleSmall, a:hover.arrowPurpleSmall { American Society of Plastic Surgeons (ASPS). No data were provided on loss to follow-up. 1999;103(6):1682-1686. Surgeon. Plast Reconstr Surg. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Fagerlund A, Lewin R, Rufolo G, et al. 2014;20(3):274-278. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. 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. Marshall WA, Tanner JM.
Does Health Insurance Cover Breast Reduction Surgery? - GoodRx Plast Reconstr Surg. 1993;91(7):1270-1276. There were 18 out of 415 studies eligible to review. 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. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. This may lead to additional scarring and additional operating time. 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. Breast J. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. 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. @media print { 2005;55(3):227-231. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. The Breast: Comprehensive Management of Benign and Malignant Diseases. 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. Horm Res Paediatr. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Surgical treatment is indicated when medical treatments fail. Level of Evidence = IV. Socioeconomic Committee Position Paper.
Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline display: block;
Breast Reduction Surgery | Johns Hopkins Medicine margin-top: 38px; Plast Reconstr Surg. Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. Plastic Reconstr Surg. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Surgical implications of obesity. Patient demographics, surgical technique, and outcomes were analyzed. 2 . J Pediatr Surg. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Ann Plast Surg. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. text-decoration: line-through; Khan SM, Smeulders MJ, Van der Horst CM. 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. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic 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.
Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. 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. Pain/discomfort/ulceration from bra straps cutting into shoulders; Skin breakdown (severe soft tissue infection, tissue necrosis, ulceration hemorrhage) from overlying breast tissue; There is a reasonable likelihood that the member's symptoms are primarily due to macromastia; Reduction mammoplasty (also spelled as 'mammaplasty') is likely to result in improvement of the chronic pain; Pain symptoms persist as documented by the physician despite at least a 3-month trial of therapeutic measures such as: Analgesic/non-steroidal anti-inflammatory drugs (NSAIDs) interventions and/or muscle relaxants, Dermatologic therapy of ulcers, necrosis and refractory infection, Physical therapy/exercises/posturing maneuvers, Supportive devices (e.g., proper bra support, wide bra straps), Chiropractic care or osteopathic manipulative treatment. A cohort study of breast cancer risk in breast reduction patients. A total of 81 patients were included in this study. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. J Am Coll Surg. This Clinical Policy Bulletin may be updated and therefore is subject to change.
Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) Leclere FM, Spies M, Gohritz A, Vogt PM. Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. 1994;21(3):539-543. 2017;139(6):1313-1322. Tang CL, Brown MH, Levine R, et al. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Gynecomastia. 2010;45(3):650-654. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Ann Plast Surg. breast augmentation with implant. OL OL OL LI { 2015;75(4):370-375. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Obstet Gynecol Clin North Am. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. N Engl J Med. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. } Gynecomastia in patients with prostate cancer: Update on treatment options. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. 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 . Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. background-color: #cc0066; Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Level of Evidence = IV. Recommended criteria for insurance coverage of reduction mammoplasty. position: fixed; li.bullet { The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. American Society of Plastic and Reconstructive Surgery (ASPRS). 1998;49:215-234. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US).
What are Aetna breast reduction requirements? - RealSelf.com 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. 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. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. } Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. 2006;9(2):109-114. 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. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. Fischer JP, Cleveland EC, Shang EK, et al. World J Surg. 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). Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Women's Health and Cancer Rights Act of 1998. Obesity and complications in breast reduction surgery: Are restrictions justified? See Appendix for Table 1. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Ann Plast Surg. Plast Reconstr Surg. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Philadelphia, PA: W.B. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. 2009;7(2):114-119. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. 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%. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Ann Chir Plast Esthet. Surgical treatment of primary gynecomastia in children and adolescents. bottom: 20px; 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. color: #FFF; 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. 2001;76(5):503-510. Plast Reconstr Surg. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. 2009;62(2):195-199. Gland Surg. 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. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. 2nd ed. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Scand J Plast Reconstr Hand Surg. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Breast hypertrophy. 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]). 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. Refer to the member's specific plan document for applicable coverage. 40 . You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 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. } 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. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Current concepts in gynaecomastia. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Plast Reconstr Surg. 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