1999;103(6):1687-1690. ASPS clinical practice guideline summary on reduction mammaplasty. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Refer to the member's specific plan document for applicable coverage. In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. 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. display: none; Aesthetic Plast Surg. Can objective predictors for operative success be identified? 1994;21(3):539-543. Surgeon. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. 2011;128(4):243e-249e. 2005;55(3):227-231. Gland Surg. Obstet Gynecol Clin North Am. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). To get insurance coverage, you'll probably need . The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Exposure to partners using estrogen containing vaginal creams; Cancer chemotherapy (alkylating agents, methotrexate, vinca alkaloids, imatinib, combination chemotherapy), Androgen receptor blockers - bicalutamide, 5 reductase inhibitors - finasteride, dutasteride, Angiotensin converting enzyme inhibitors (captopril, enalapril), Calcium channelblockers(diltiazem, nifedipine, verapamil), Anabolic steroids(e.g., in body builders). Breast reduction, 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). 1998;101(2):361-364. 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). top: 0px; The Mammotome procedure represented another novel therapeutic option for gynecomastia. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. 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). Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? The authors reach the remarkable conclusion that a woman with normal sized breasts who has only a few ounces of breast tissue removed is as likely to receive as much benefit from breast reduction surgery as a women with large breasts who has substantially more breast tissue removed. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. Gynecomastia is a very common concern of male adolescence. In other patients, excess skin and nipple and areola relocation are necessary. 1. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Arlington Heights, IL: ASPS; May 2011. Also, there was no correlation between PR expression and 2D: 4D. display: block; Lonie S, Sachs R, Shen A, et al. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Burns JL, Blackwell SJ. 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. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. 2018;7(Suppl 1):S70-S76. Patient demographics, surgical technique, and outcomes were analyzed. Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). 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 . Surgery. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Aesthetic Plast Surg. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. 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). 2003;111(2):688-694. 1998;49:215-234. Wound drainage after plastic and reconstructive surgery of the breast. Ann Plast Surg. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. 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. } Surg Laparosc Endosc Percutan Tech. 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. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Surgical treatment is indicated when medical treatments fail. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Principles of breast re-reduction: A reappraisal. Plast Reconstr Surg. Plastic Reconstruct Surg. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. color: red 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. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. #closethis { padding: 15px; A cohort study of breast cancer risk in breast reduction patients. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. ASPS Recommended Coverage Criteria for Third Party Payors. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Three review authors undertook independent screening of the search results. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. 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. Abnormalities in Adolescent Breast Development. margin-top: 38px; There were no restrictions on the basis of date or language of publication. 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. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). 2015;49(6):363-366. Krieger LM, Lesavoy MA. 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. of . Laituri CA, Garey CL, Ostlie DJ, et al. Ann Plast Surg. Breast J. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. 2004;113(1):436-437. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Policy. 2006;118(4):840-848. Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). Socioeconomic Committee Position Paper. Ann Plastic Surg. A detailed physical examination, including testicular examination. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. hr.separator { Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Ages ranged from 18 to 66 years. of the following criteria must be met: Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Hello! Mistry RM, MacLennan SE, Hall-Findlay EJ. No author listed. cursor: pointer; J Plast Surg Hand Surg. 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. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. When seeking preauthorization for a breast reduction, your goal is generally twofold. 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. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. 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. 2015;10(8):e0136094. Plast Reconstr Surg. # font-weight: bold; Aesthetic Plast Surg. Risk of bias was assessed independently by 2review authors. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Townsend: Sabiston Textbook of Surgery. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). This will be computed based on your body area. Collis N, McGuiness CM, Batchelor AG. 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. Management of gestational gigantomastia. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. 2000;44(2):125-134. Kerrigan CL, Collins ED, Kim HM, et al. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. J Plast Surg Hand Surg. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Variations in pattern of pubertal changes in girls. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. # color: white; 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. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Plastic Reconstruct Surg. American Society of Plastic Surgeons (ASPS). 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). 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. 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. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Plast Reconstr Surg. 2013;71(5):471-475. 2014a;34(1):66-73. 1993;91(7):1270-1276. Breast hypertrophy. color: blue!important; A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. 1995;95(6):1029-1032. J Plast Surg Hand Surg.
aetna breast reduction requirements
