The mean age was 42.8 years (SD 19.5 years). Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna 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. font-size: 18px; The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. Sood R, Mount DL, Coleman JJ 3rd, et al. Blomqvist L, Eriksson A, Brandberg Y. The majority (87.7 %) of cases presented with accompanying mastalgia. Variations in pattern of pubertal changes in girls. Plast Reconstr Surg. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. The primary outcome was the difference in wound drainage over 24 hours. Current concepts in gynaecomastia. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. 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. .newText { 1991;27(3):232-237. 2001;107(5):1234-1240. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. 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. Last Review01/04/2023. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. J Plast Reconstr Aesthet Surg. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Rising Rates of Insurance Denial for Breast Reduction Surgery Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. .newText { The risks included infection, wound breakdown, scarring, and the need for re-operating. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. 2019;166(5):934-939. 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). padding: 15px; Fischer S, Hirsch T, Hirche C, et al. list-style-type: decimal; right: 30px; Pediatr Surg Int. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note Ann Plast Surg. PLoS One. 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). Risk factors for complications following breast reduction: Results from a randomized control trial. 1. Breast pumps. .fixedHeaderWrap { Breast J. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. Aesthet Surg J. Laituri CA, Garey CL, Ostlie DJ, et al. #backTop:hover { Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. hr.separator { Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Level of Evidence = III. American Society of Plastic Surgeons (ASPS). Nguyen JT, Wheatley MJ, Schnur PL, et al. Ann Plast Surg. Schnur PL, Hoehn JG, Ilstrup DM, et al. 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). /*margin-bottom: 43px;*/ (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. Plast Reconstr Surg. 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. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Yao Y, Yang Y, Liu J, et al. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. 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. Ann Plast Surg. 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. 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. Gonzalez FG, Walton RL, Shafer B, et al. 2007;119(4):1159-1166. Recommended criteria for insurance coverage of reduction mammoplasty. Guidelines for Adolescent Health Care. Well-designed trials are especially important in assessing pain management interventions to isolate the contribution of the intervention from placebo effects, the effects of other concurrently administered pain management interventions, and the natural history of the medical condition. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. 2000;44(2):125-134. 2004;113(1):436-437. Annu Rev Med. 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. 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. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Reduction mammoplasty improves symptoms of macromastia. } I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. 2015;75(4):370-375. Br J Plast Surg. Evidence-based clinical practice guideline: Reduction mammaplasty. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. 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. 2010;45(3):650-654. No data were provided on loss to follow-up. Li CC, Fu JP, Chang SC, et al. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. --> In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Resolution of idiopathic gynecomastia may take several months to years. 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. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. 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. Aesthetic Plast Surg. 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. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Also, there was no correlation between PR expression and 2D: 4D. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. 2014a;34(1):66-73. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Breast J. color: white; Ann Chir Plast Esthet. OL LI { list-style-type: upper-alpha; .strikeThrough { In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Analysis was on an intention-to-treat basis. 2008;121(4):1092-1100. 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. A detailed physical examination, including testicular examination. Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for 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. 1993;91(7):1270-1276. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Does Aetna Cover Breast Reduction? | HelpAdvisor.com No new trials were identified for this first update. Hoyos AE, Perez ME, Dominguez-Millan R, et al. } Breast Reduction Surgery | Johns Hopkins Medicine } 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. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Araco A, Gravante G, Araco F, et al. Collins ED, Kerrigan CL, Kim M, et al. In a systematic review, these investigators examined the role of radiotherapy in this context. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. 2012;130(4):785-789. Refer to the member's specific plan document for applicable coverage. A physician-supervised diet and exercise plan may be indicated in obese patients. 2009;62(2):195-199. No necrosis, systemic infection, or muscle paralysis was reported. Many men with breast enlargement are found to have pseudo-gynecomastia. Fagerlund A, Lewin R, Rufolo G, et al. Aesthet Surg J. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. 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. Philadelphia, PA: W.B. } The health burden of breast hypertrophy. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. cursor: pointer; Arlington Heights, IL: ASPRS; 1987. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. } All the patients recovered well and were satisfied with the cosmetic outcomes. J Plast Reconstr Aesthet Surg. Socioeconomic Committee Position Paper. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Long-term functional results after reduction mammoplasty. .headerBar { Townsend: Sabiston Textbook of Surgery. Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. There were 18 out of 415 studies eligible to review. Ages ranged from 18 to 66 years. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Surgery. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Khan SM, Smeulders MJ, Van der Horst CM. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. # color: white; Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Breast and aesthetic surgery. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare 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. position: fixed; Plastic Reconstr Surg. text-decoration: line-through; Reduction mammoplasty: Criteria for insurance coverage. 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.. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Grooving where the bra straps sit on the shoulder. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Arlington Heights, IL: ASPS; 2011. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. 1995;34(2):113-116. 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". Lonie S, Sachs R, Shen A, et al. 2007;356(5):479-485. Breast Concerns of Adolescents. Breast. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. } Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. My Experience of Having Breast Reduction Surgery - Health Ann Plast Surg. list-style-type : square !important; Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). There were no restrictions on the basis of date or language of publication. 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. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Ann Plast Surg. American Society of Plastic Surgeons (ASPS). 2019;8(4):431-440. } The nipple-areola complex was re-positioned in 60 % of patients (n = 54). 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). Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass In these cases, breast reduction for men may take 2 to 3 hours. The study subjects were stratified into groups based on ages of <60 years and 60 years. This may lead to additional scarring and additional operating time. 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). Treatment of adolescent gynecomastia. American Society of Plastic Surgeons (ASPS). 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. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Type II gynecomastia is more generalized breast enlargement. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. In other patients, excess skin and nipple and areola relocation are necessary. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. Major complications (1.6 %) included unilateral hematoma and localized infection. 2015;49(6):311-318. Gland Surg. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Is breast reduction covered by health insurance? | ASPS 2014;20(3):274-278. Plast Reconstr Surg. Abnormalities in Adolescent Breast Development. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Ann Plastic Surg. 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. 2006;118(4):840-848. Can objective predictors for operative success be identified? This will be computed based on your body area. OL OL OL LI { 2017;139(6):1313-1322. padding: 10px; Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). 2000;106(5):991-997. 2001;76(5):503-510. 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). Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Subjects were compared to age-matched norms from another study cohort. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). PDF Procedures, programs and drugs you must precertify - AmeriBen For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Policy Statement 6d: Aesthetic surgery procedures. of the following criteria must be met: PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Quality of life after breast reduction. background-color: #cc0066; @media print { For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Another set of breast pump supplies if you get pregnant . However, these medications should be reserved for those with no decrease in breast size after 2 years. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. padding-right: 18px; Plast Reconstr Surg. For individuals who received radiation treatment to the chest . J Pediatr Surg. 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. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. color: blue Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. 2017;35:157-161. 2018;7(Suppl 1):S70-S76. Handschin AE, Bietry D, Hsler R, et al.