Recommended criteria for insurance coverage of reduction mammoplasty. Qu S, Zhang W, Li S, et al. 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. Measuring health state preferences in women with breast hypertrophy. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. 2001;108(1):62-67. cursor: pointer; However, it is unclear if there is any evidence to support this practice. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Arch Dis Child. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com The risks included infection, wound breakdown, scarring, and the need for re-operating. Patient demographics, surgical technique, and outcomes were analyzed. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna 1993;91(7):1270-1276. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 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. Another set of breast pump supplies if you get pregnant . 2009;19(3):e85-e90. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. 2001;108(6):1591-1599. and areola. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. A total of 81 patients were included in this study. They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. 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. 2011;128(4):243e-249e. 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. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. 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. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. text-decoration: line-through; 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. They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. --> Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. 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). Khan SM, Smeulders MJ, Van der Horst CM. } 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). Surgical treatment of gynecomastia: Complications and outcomes. The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. bottom: 20px; Current concepts in gynaecomastia. Special Clinical Concerns. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Plast Reconstr Surg. Variations in pattern of pubertal changes in girls. Schnur PL, Schnur DP, Petty PM, et al. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Blomqvist L, Eriksson A, Brandberg Y. #backTop:hover { 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Kerrigan CL, Collins ED, Kneeland TS, et al. 2014a;34(3):409-416. } 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. Surgeon. color: white; The Breast: Comprehensive Management of Benign and Malignant Diseases. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Management of gestational gigantomastia. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. 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). 2000;45(6):575-580. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Plast Reconstr Surg. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; # font-weight: bold; Brown DM, Young VL. Statistical analysis was performed with student t-test and chi-square test. } Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Emiroglu M, Salimoglu S, Karaali C, et al. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline Many men with breast enlargement are found to have pseudo-gynecomastia. background: #5e9732; Bland KI, Copeland EM, eds. Magnetic Resonance Imaging (MRI) of the Breast - Aetna The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. 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. Refer to the member's specific plan document for applicable coverage. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. 2015;75(4):383-387. A total of 244 out of 1,628 patients with the average age of 23.13 years. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. 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. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Collins ED, Kerrigan CL, Kim M, et al. Level of Evidence = IV. 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: Reduction mammoplasty for asymptomatic members is considered cosmetic. J Plast Reconstr Aesthet Surg. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Ann Plast Surg. A systematic search of the published literature was performed. 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. Plast Reconstr Surg. Cochrane Database Syst Rev. There were no restrictions on the basis of date or language of publication. Handschin AE, Bietry D, Hsler R, et al. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Wound drainage after plastic and reconstructive surgery of the breast. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). display: none; Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. 2017;139(6):1313-1322.
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