display: block; He Q, Zheng L, Zhuang D, et al. 2008;32(1):38-44. 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). No other operation-related complications were observed. Policy Statement 6d: Aesthetic surgery procedures. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Patient demographics, surgical technique, and outcomes were analyzed. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Plastic Reconstr Surg. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Arch Dis Child. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Quality of life after breast reduction. 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. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Macromastia: all . Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. 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. These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. 2000;106(2):280-288. } The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. 1997;100(4):875-883. color: red!important; Plast Reconstr Surg. World J Surg. American Society of Plastic Surgeons (ASPS). Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. padding-right: 18px; 2015;49(6):311-318. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Breast hypertrophy. cursor: pointer; 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. Plast Reconstr Surg. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. For individuals who received radiation treatment to the chest . OL OL LI { The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Leclere FM, Spies M, Gohritz A, Vogt PM. Well-designed clinical trials provide reliable information about the effectiveness of an intervention, and provide valid information about the characteristics of patients who would benefit from that intervention. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. background: #5e9732; J Plast Reconstr Aesthet Surg. The Breast: Comprehensive Management of Benign and Malignant Diseases. (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. 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. Gynecomastia is a very common concern of male adolescence. ul.ur li{ 1993;91(7):1270-1276. Aesthet Surg J. Please check your insurance policy to see whether breast reduction is a covered procedure. 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. Wound drainage after plastic and reconstructive surgery 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: Fagerlund A, Lewin R, Rufolo G, et al. li.bullet { Bland KI, Copeland EM, eds. 2008;121(4):1092-1100. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Computed tomography scan of adrenal glands to identify adrenal lesions. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. Last Review01/04/2023. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Little is known about the effect of surgical treatment on the psychological aspects of the disease. 1999;103(6):1687-1690. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. 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. Follow-up ranged from 2 months to 3 years. border: none; text-decoration: line-through; A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. In other patients, excess skin and nipple and areola relocation are necessary. 2 . Qu S, Zhang W, Li S, et al. Collins ED, Kerrigan CL, Kim M, et al. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. Gynecomastia in patients with prostate cancer: Update on treatment options. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. 2005;58(3):286-289. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. 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). Obstet Gynecol Clin North Am. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. The health burden of breast hypertrophy. Pediatr Surg Int. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Horm Res Paediatr. 1997;185(6):593-603. Abnormalities in Adolescent Breast Development. 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). Statistical analysis was performed with student t-test and chi-square test. PLoS One. Am 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. #backTop:hover { Special Clinical Concerns. list-style-type: upper-roman; 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. To get insurance coverage, you'll probably need . The risks included infection, wound breakdown, scarring, and the need for re-operating. Surgeon. Devalia HL, Layer GT. A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. Subjects were compared to age-matched norms from another study cohort. #backTop { Sood R, Mount DL, Coleman JJ 3rd, et al. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. 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. /*margin-bottom: 43px;*/ Gland Surg. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. cursor: pointer; Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). 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. of the following criteria must be met: A total of 15 articles met the inclusion criteria for review. The study subjects were stratified into groups based on ages of <60 years and 60 years. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Am J Infect Control. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Ann Plast Surg. Analysis was on an intention-to-treat basis. Scand J Plast Reconstr Hand Surg. Guidelines for Adolescent Health Care. 2015;10(8):e0136094. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Handschin AE, Bietry D, Hsler R, et al. Links to various non-Aetna sites are provided for your convenience only. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 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]). The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 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. In these cases, breast reduction for men may take 2 to 3 hours. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. /* aetna.com standards styles for templates */ 2003;111(2):688-694. Schnur PL, Schnur DP, Petty PM, et al. The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. 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). 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. Breast. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? 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. breast augmentation with implant. 2014a;34(1):66-73. 2015;(10):CD007258. Plastic Reconstruct Surg. 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. 2021;74(11):3128-3140. 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. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Ages ranged from 18 to 66 years. 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. 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. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. There were only 2 studies of a total 25 patients that were considered as good in quality. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. color: white; The Mammotome procedure represented another novel therapeutic option for gynecomastia. Breast J. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Administration of Benefits and Transition Responsibilities Miller AP, Zacher JB, Berggren RB, et al. text-decoration: underline; Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Asian J Surg. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. 1994;21(3):539-543. All the patients recovered well and were satisfied with the cosmetic outcomes. 2002;109(5):1556-1566. Breast reduction outcome study. The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. 1. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. margin-bottom: 38px; Fagerlund A, Cormio L, Palangi L, et al. Another set of breast pump supplies if you get pregnant . A physician-supervised diet and exercise plan may be indicated in obese patients. However, these medications should be reserved for those with no decrease in breast size after 2 years.
aetna breast reduction requirements