aetna breast reduction requirements

hr.separator { Ann Plastic Surg. No new trials were identified for this first update. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. 1993;91(7):1270-1276. 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. }. Am J Infect Control. 2007;36(2):497-519. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. Emiroglu M, Salimoglu S, Karaali C, et al. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. list-style-type: upper-roman; Nguyen JT, Wheatley MJ, Schnur PL, et al. cursor: pointer; OL OL OL LI { A detailed physical examination, including testicular examination. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. American Society of Plastic Surgeons (ASPS). Special Clinical Concerns. Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. 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. Washington, DC: ACOG; 2011:121-122. Surgical implications of obesity. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Bertin ML, Crowe J, Gordon SM. Ann Plast Surg. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. 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.. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. 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. No necrosis, systemic infection, or muscle paralysis was reported. Breast reduction outcome study. Wound drainage after plastic and reconstructive surgery of the breast. ASPS clinical practice guideline summary on reduction mammaplasty. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. 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]). Follow-up ranged from 2 months to 3 years. There were only 2 studies of a total 25 patients that were considered as good in quality. Br J Plast Surg. Plast Reconstr Surg. Petty PM, Solomon M, Buchel EW, Tran NV. Reduction mammoplasty: Criteria for insurance coverage. Plastic Reconstruct Surg. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. 1998;49:215-234. Plast Reconstr Surg. 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. Breast. Lonie S, Sachs R, Shen A, et al. Plast Reconstr Surg. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. 2017;139(6):1313-1322. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). For medical Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Collins ED, Kerrigan CL, Kim M, et al. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Gland Surg. Seitchik MW. Autorino R, Perdona S, D'Armiento M, et al. Setala L, Papp A, Joukainen S, et al. color: #FFF; } OL OL OL OL OL LI { Plast Reconstr Surg. 2000;44(2):125-134. Flancbaum L, Choban PS. It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. Abnormalities in Adolescent Breast Development. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. 2005;55(3):227-231. 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. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. } Because reduction mammoplasty may be used for both medically necessary and cosmetic indications, Aetna has set forth above objective criteria to distinguish medically necessary reduction mammoplasty from cosmetic reduction mammoplasty. 1999;103(6):1674-1681. Fischer JP, Cleveland EC, Shang EK, et al. } All the patients recovered well and were satisfied with the cosmetic outcomes. If an insufficient amount of breast tissue is removed, the surgery is less likely to be successful in relieving pain and any related symptoms from excessive breast weight (e.g., excoriations, rash). Plastic Reconstr Surg. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. border-radius: 4px; Prepubertal gynecomastia linked to lavender and tea tree oils. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. 2006;118(4):840-848. 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 Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Plast Reconstr Surg. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. 2011;128(4):243e-249e. skin should not be excised horizontally below the inframammary fold. Refer to the member's specific plan document for applicable coverage. Gynecomastia in patients with prostate cancer: A systematic review. 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. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. Breast and aesthetic surgery. Can objective predictors for operative success be identified? Ann Plast 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. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 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. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Last Review01/04/2023. Often times, insurance company will dictate how much breast tissue to be removed. Also, there was no correlation between PR expression and 2D: 4D. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Kalliainen LK; ASPS Health Policy Committee. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Obstet Gynecol Clin North Am. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Aesthetic Plast Surg. 2004;113(1):436-437. 1995;34(2):113-116. Endocrinol Metab Clin North Am. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Determinants of surgical site infection after breast surgery. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Other just require 500 grams no matter what your height and weight. The authors concluded that the limited evidence available showed no significant benefit of using post-operative wound drains in reduction mammoplasty, although LOS may be shorter when drains are not used. 2015;49(6):311-318. Plast Reconstr Surg. 2015;49(6):363-366. Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. } color: red Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. color:#eee; The authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). 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). 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. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Arlington Heights, IL: ASPS; May 2011. No other operation-related complications were observed. Horm Res Paediatr. 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). --> This investigators stated that these studies should include data from older individuals affected by gynecomastia and utilize valid tools of psychological measurement in order to better quantify the effect; elderly patients affected by the disease have been over-looked in the current research; more data on this subject could improve the pre-operative evaluation of these patients and help identify the patients who will benefit from treatment. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. 1993;17(3):211-223. He Q, Zheng L, Zhuang D, et al. Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. 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. Brown MH, Weinberg M, Chong N, et al. 2020 Sep 4 [Online ahead of print]. Philadelphia, PA: W.B. The study subjects were stratified into groups based on ages of <60 years and 60 years. 1998;26(1):61-65. z-index: 99; 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). J Plast Reconstr Aesthet Surg. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. Schnur PL, Schnur DP, Petty PM, et al. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Krieger LM, Lesavoy MA. This will be computed based on your body area. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Administration of Benefits and Transition Responsibilities Mizgala CL, MacKenzie KM. Reduction mammoplasty improves symptoms of macromastia. Reduction mammoplasty for asymptomatic members is considered cosmetic. 2014;20(3):274-278. Anesthesia may be injected along with saline solution until the tissue is firm, and a suction cannula is used to extract fat from the breast. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. 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. Ann Plast 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. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Reduction mammaplasty: The need for prospective randomized studies. Chadbourne EB, Zhang S, Gordon MJ, et al. } A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Gynecomastia: Evolving paradigm of management and comparison of techniques. Kerrigan CL, Collins ED, Kneeland TS, et al. 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. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Plastic Reconstruct Surg. World J Surg. Breast J. Another set of breast pump supplies if you get pregnant . You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. Plast Reconstr Surg. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. Surgical treatment of gynecomastia: Complications and outcomes. 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. 2018;7(Suppl 1):S70-S76. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Burns JL, Blackwell SJ. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. 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. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Computed tomography scan of adrenal glands to identify adrenal lesions. Surgery. Mistry RM, MacLennan SE, Hall-Findlay EJ. (25 y/o female with a 38J bra size) according to aetna, I should more than qualify for a reduction as I have back, neck, shoulder pain, chest pain and pressure, arm numbness while laying on sides, etc. The end-point was the complete resolution of gynecomastia. Kerrigan CL, Collins ED, Kim HM, et al. In a systematic review, these investigators examined the role of radiotherapy in this context. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. 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. 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. GP Notebook. 1998;41(3):240-245. Prostate Cancer Prostatic Dis. A follow-up study of 105 women with breast cancer following reduction mammaplasty. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Principles of breast re-reduction: A reappraisal. } Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. 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 LI { 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. J Laparoendosc Adv Surg Tech A. All RCTs that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Surg Laparosc Endosc Percutan Tech. The average age was 24.7 years (range of 18 to 47 years). .fixedHeaderWrap { } The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Arch Dis Child. 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. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. background: #5e9732; 2021 Aug 11 [Online ahead of print]. 2019;8(4):431-440. Analysis was on an intention-to-treat basis. Devalia HL, Layer GT. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle.

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