Breast J. padding: 15px; The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. A total of 244 out of 1,628 patients with the average age of 23.13 years. Reduction mammoplasty improves symptoms of macromastia. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Plast Reconstr Surg. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Nguyen JT, Wheatley MJ, Schnur PL, et al. ASPS clinical practice guideline summary on reduction mammaplasty. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 2007;119(4):1159-1166. bottom: 20px; These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Fagerlund A, Lewin R, Rufolo G, et al. Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). A study by Bruhlmann and Tschopp (1998) was a retrospective study of 246 patients from a surgical practice, approximately 50 % (132) of whom returned a questionnaire about their symptoms and satisfaction with aesthetic results, and their recollection of symptoms prior to surgery. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. } 2001;76(5):503-510. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Quality of life after breast reduction. 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. Yao Y, Yang Y, Liu J, et al. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note 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. J Plast Surg Hand Surg. Gynecomastia is a very common concern of male adolescence. Reduction mammoplasty for asymptomatic members is considered cosmetic. An 18-question survey was created evaluating various aspects of BBR practice; UK and Irish plastic and reconstructive and breast surgeons were invited to participate by an e-mail containing a link to a web-based survey. 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. Mizgala CL, MacKenzie KM. Surgical treatment of primary gynecomastia in children and adolescents. Gynecomastia has been classified into2 types. 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. of . 2015;75(4):370-375. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Plast Reconstr Surg. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. Breast reduction surgery - Mayo Clinic The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. Ann Plast Surg. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. A population-level analysis of bilateral breast reduction: does age affect early complications? Ages ranged from 18 to 66 years. 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. #backTop:hover { Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Kerrigan CL, Collins ED, Striplin D, et al. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. OL LI { Subjects were compared to age-matched norms from another study cohort. Plastic Reconstr Surg. color: blue Brown MH, Weinberg M, Chong N, et al. Level of Evidence = IV. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). My Experience of Having Breast Reduction Surgery - Health Plast Reconstr Surg. 2002;109(5):1556-1566. 2014a;34(3):409-416. PDF 0185 Breast Reconstructive Surgery (1) - Aetna Breast hypertrophy. color:#eee; There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). 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. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Oxfordshire NHS Trust. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. The end-point was the complete resolution of gynecomastia. Kerrigan CL, Collins ED, Kim HM, et al. 2002;33:208-217. 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. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Ann Plast Surg. Plast Reconstr Surg. 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.. Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. Plastic Reconstr Surg. Chadbourne EB, Zhang S, Gordon MJ, et al. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Philadelphia, PA: W.B. Plast Reconstr Surg. 1991;27(3):232-237. Breast pumps. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Plastic Reconstruct Surg. Other just require 500 grams no matter what your height and weight. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. 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. } He Q, Zheng L, Zhuang D, et al. 2004;113(1):436-437. background-color: #663399; Surgical treatment is indicated when medical treatments fail. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne American Society of Plastic Surgeons (ASPS). 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. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Can objective predictors for operative success be identified? Treatment of adolescent gynecomastia. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. 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. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Does Aetna Cover Breast Reduction? | HelpAdvisor.com Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. border-radius: 4px; Reduction mammaplasty: The need for prospective randomized studies. Plast Reconstr Surg. Leclere FM, Spies M, Gohritz A, Vogt PM. Rising Rates of Insurance Denial for Breast Reduction Surgery With approval from the authors institutional ethics committee and written informed consent, a total of 22 patients with 33 abnormally hyperplastic breasts were enrolled at the First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. 2012;69(5):510-515. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Marshall WA, Tanner JM. background-position: right 65%; cursor: pointer; Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. The majority (87.7 %) of cases presented with accompanying mastalgia. 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. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. 2016;20(3):256-260. This conclusion is based primarily upon the Breast Reduction Assessment of Value and Outcomes (BRAVO) study, which is described in several articles (Kerrigan et al, 2001; Kerrigan et al, 2002; Collins et al, 2002). Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. 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. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Policy Statement 6d: Aesthetic surgery procedures. Gynecomastia in patients with prostate cancer: Update on treatment options. 2010;45(3):650-654. This Clinical Policy Bulletin may be updated and therefore is subject to change. color: #FFF; Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. Gynaecomastia. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Asian J Surg. 1993;17(3):211-223. No other operation-related complications were observed. 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 Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Oxford, UK: National Health Service (NHS); October 2008. Patient demographics, surgical technique, and outcomes were analyzed. Aetna considers breast reconstructive surgery to correct Surgical treatment of gynecomastia by vacuum-assisted biopsy device. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Also, there was no correlation between PR expression and 2D: 4D. Plast Reconstr Surg. Ann Plast Surg. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. }. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. list-style-type: decimal; 1999;103(1):76-82; discussion 83-85. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. 2008;53(3):255-261. 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). Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. And if you are in Canada the surgeon decides. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. .newText { } 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). Surgical implications of obesity. Surgery. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; 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. 1997;185(6):593-603. 1999;103(6):1682-1686. } Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Miller AP, Zacher JB, Berggren RB, et al. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Fischer JP, Cleveland EC, Shang EK, et al. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. 01/04/2023 OL OL OL OL LI { In the case of breast reduction, however, for insurance purposes, it . The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). Breast. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Mayo Clin Proc. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. breast augmentation with implant. 2008;32(1):38-44. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . No data were provided on loss to follow-up. li.bullet { A detailed physical examination, including testicular examination. PDF A look at new changes coming to E&M and breast coding in 2021 Am J Infect Control. Administration of Benefits and Transition Responsibilities Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. 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. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. 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. .newText { Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. @media print { Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). padding: 10px; 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. # font-weight: bold; Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Med Decis Making. Mistry RM, MacLennan SE, Hall-Findlay EJ. Hoyos AE, Perez ME, Dominguez-Millan R, et al. Current concepts in gynaecomastia. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. There were only 2 studies of a total 25 patients that were considered as good in quality. Breast reduction outcome study. Ann Plastic Surg. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. 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%. 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. Plastic Reconstruct Surg. 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. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor 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. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. PLoS One. 1996;20(5):391-397. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Araco A, Gravante G, Araco F, et al. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. The average age was 24.7 years (range of 18 to 47 years). Lonie S, Sachs R, Shen A, et al. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. Refer to the member's specific plan document for applicable coverage. Measuring health state preferences in women with breast hypertrophy. 2020 Sep 4 [Online ahead of print]. Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) Drainage in breast reduction surgery: A prospective randomised intra-patient trail. 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. If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Long-term functional results after reduction mammoplasty. Macromastia: all . In these cases, breast reduction for men may take 2 to 3 hours. 2019;166(5):934-939. American Society of Plastic Surgeons (ASPS). How to Get Your Breast Reduction Covered By Insurance - RealSelf News Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. 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). Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. 2021;74(11):3128-3140. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. 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. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. cursor: pointer; font-size: 18px; 2021;147(5):1072-1083. Breast Reduction Surgery | Johns Hopkins Medicine border: none; 1998;41(3):240-245. 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. # color: white; These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. 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:

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