aetna breast reduction requirements

A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Brown MH, Weinberg M, Chong N, et al. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. color: white; While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. For medical 2008;61(5):493-502. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Thus, more than 1/3of operative subjects selected for inclusion in the study did not complete it; most of the operative subjects who did not complete the study were lost to follow-up. Setala L, Papp A, Joukainen S, et al. Statistical analysis was performed with student t-test and chi-square test. High-risk lesions (atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], and lobular carcinoma in situ [LCIS]) were revealed in 37 (11.7 %), and cancer in 6 (1.9 %) patients. Links to various non-Aetna sites are provided for your convenience only. Gynecomastia in patients with prostate cancer: A systematic review. .fixedHeaderWrap { Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Med Decis Making. Risk factors for complications following breast reduction: Results from a randomized control trial. OL OL OL LI { Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. 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). Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Plast Reconstr Surg. background-color: #663399; 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). Type II gynecomastia is more generalized breast enlargement. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Tang CL, Brown MH, Levine R, et al. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammoplasty regarding physical symptoms and body image. background-color: #cc0066; Gland Surg. 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". Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Gynecomastia. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. 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. text-decoration: underline; Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Three review authors undertook independent screening of the search results. 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. In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Am J Infect Control. Refer to the member's specific plan document for applicable coverage. In a systematic review, these investigators examined the role of radiotherapy in this context. A detailed physical examination, including testicular examination. }. 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. 2006;9(2):109-114. 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. 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). American Society of Plastic Surgeons (ASPS). list-style-type: upper-roman; 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. Karamanos et al (2015) identified their study as the largest sample on breast reduction in the literature, in which age and surgeon specialty did not correlate with negative results. Aesthetic Plast Surg. 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. 2017;35:157-161. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. 18th ed. Plast Reconstr Surg. Women's Health and Cancer Rights Act of 1998. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). 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. .strikeThrough { 2007;119(4):1159-1166. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. These preliminary findings need to be validated by well-designed studies. of . 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). Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 2015;49(6):311-318. Priorities Forum Policy Statement. .arrowPurpleSmall, a:hover.arrowPurpleSmall { Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. # color: white; and areola. Risk of bias was assessed independently by 2review authors. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Breast hypertrophy. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Treating providers are solely responsible for medical advice and treatment of members. 2001;108(6):1591-1599. No author listed. Other just require 500 grams no matter what your height and weight. 1998;26(1):61-65. 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. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. 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). Arlington Heights, IL: ASPS; March 9, 2002. 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. Plast Reconstr Surg. ASPS clinical practice guideline summary on reduction mammaplasty. 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. There were no restrictions on the basis of date or language of publication. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. 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%. 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. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. 2021;147(5):1072-1083. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. ol.numberedList LI { cursor: pointer; Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Ann Chir Plast Esthet. No other operation-related complications were observed. Reduction mammoplasty for asymptomatic members is considered cosmetic. Coding Surg Laparosc Endosc Percutan Tech. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Arlington Heights, IL: ASPRS; 1987. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. #backTop { Plast Reconstr Surg. Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? Aesthet Surg J. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. 2005;58(3):286-289. } 2014;20(3):274-278. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. 1994;21(3):539-543. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Khan SM, Smeulders MJ, Van der Horst CM. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. 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. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Major complications (1.6 %) included unilateral hematoma and localized infection. Kerrigan CL, Collins ED, Kneeland TS, et al. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Grooving where the bra straps sit on the shoulder. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). See Appendix for Table 1. 2005;55(3):227-231. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. The majority (87.7 %) of cases presented with accompanying mastalgia. 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. 2003;111(2):688-694. Gynecomastia: Evolving paradigm of management and comparison of techniques. Current concepts in gynaecomastia. Howrigan P. Reduction and augmentation mammoplasty. 2009;19(3):e85-e90. # font-weight: bold; --> Breast. 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. Krieger LM, Lesavoy MA. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Plastic surgery for teenagers briefing paper. 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. 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. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. Miller AP, Zacher JB, Berggren RB, et al. Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. } Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Gynaecomastia. Plast Reconstr Surg. 2016;20(3):256-260. Aesthet Surg J. Flancbaum L, Choban PS. 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. 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 liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). 2006;30(3):309-319. list-style-type: decimal; Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. 1995;95(1):77-83. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. 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. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Am Surg. 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. Hello! list-style-type: lower-alpha; As explained below, 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. Br J Plast Surg. 1998;49:215-234. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). A total of 244 out of 1,628 patients with the average age of 23.13 years. 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). Mayo Clin Proc. 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: Annu Rev Med. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. 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. 2008;32(1):38-44. background-position: right 65%; 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. Also, there was no correlation between PR expression and 2D: 4D. Level of Evidence = III. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. 1993;17(3):211-223. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). 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).

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