Level of Evidence = IV. No necrosis, systemic infection, or muscle paralysis was reported. 1999;103(6):1682-1686. 1994;21(3):539-543. Araco A, Gravante G, Araco F, et al. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. Major complications (1.6 %) included unilateral hematoma and localized infection. Br J Plast Surg. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. 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). 1998;49:215-234. 2009;7(2):114-119. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. In other patients, excess skin and nipple and areola relocation are necessary. background-color: #cc0066; text-decoration: underline; 2015;49(6):363-366. Arlington Heights, IL: ASPRS; 1987. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. width: 100%; Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. Plast Reconstr Surg. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Collis N, McGuiness CM, Batchelor AG. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Plast Reconstr Surg. Copyright Aetna Inc. All rights reserved. Recommended criteria for insurance coverage of reduction mammoplasty. 2010;45(3):650-654. border-width:0; A non-standardized survey showed a very high satisfaction index. 1993;91(7):1270-1276. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. and areola. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Gynecomastia in patients with prostate cancer: A systematic review. 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. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Gonzalez FG, Walton RL, Shafer B, et al. 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. 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. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. 2014b;48(5):334-339. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. color: red!important; Little is known about the effect of surgical treatment on the psychological aspects of the disease. } 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. Aetna considers magnetic resonance imaging (MRI), with or without contrast materials, of the breast medically necessary for members who have had a recent (within the past year) conventional mammogram and/or breast sonogram, in any of the following circumstances where MRI of the breast may affect their clinical management:. Bland KI, Copeland EM, eds. This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast. Breast Concerns of Adolescents. 1991;27(3):232-237. 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). 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". Last Review01/04/2023. Fischer JP, Cleveland EC, Shang EK, et al. display: block; 2001;108(1):62-67. J Plast Reconstr Aesthet Surg. Ann Plast Surg. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Gynecomastia has been classified into2 types. Flancbaum L, Choban PS. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. @media print { Mental health care professionals may be consulted to address psychological distress from gynecomastia. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. To get insurance coverage, you'll probably need . Reduction mammaplasty: The need for prospective randomized studies. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. } } 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. Prepubertal gynecomastia linked to lavender and tea tree oils. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Arlington Heights, IL: ASPS; 2011. 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. Seitchik MW. A total of 81 patients were included in this study. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. 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. Arch Dis Child. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Three review authors undertook independent screening of the search results. This will be computed based on your body area. Arlington Heights, IL: ASPS; March 9, 2002. Special Clinical Concerns. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. 2021 Aug 11 [Online ahead of print]. color: white; .strikeThrough { Plast Reconstr Surg. 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. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. } 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. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 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. A systematic search of the published literature was performed. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Obesity and complications in breast reduction surgery: Are restrictions justified? Reduction mammaplasty: Defining medical necessity. 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. Surgical treatment is indicated when medical treatments fail. 2014;20(3):274-278. PDF 0185 Breast Reconstructive Surgery (1) - Aetna Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. Plast Reconstr Surg. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. 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. Socioeconomic Committee Position Paper. The average age was 24.7 years (range of 18 to 47 years). 1999;103(6):1687-1690. 2017;139(6):1313-1322. #backTop:hover { Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. hr.separator { color: #FFF; 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. #closethis { Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Obstet Gynecol Clin North Am. 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). 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. Gland Surg. 1993;17(3):211-223. 1995;61(11):1001-1005. Howrigan P. Reduction and augmentation mammoplasty. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. 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. 2007;119(4):1159-1166. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. When seeking preauthorization for a breast reduction, your goal is generally twofold. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. 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. Leclere FM, Spies M, Gohritz A, Vogt PM. 1996;20(5):391-397. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Med Decis Making. 2018;24(6):1043-1045. Surgery. Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass 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). Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. 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. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. cursor: pointer; He Q, Zheng L, Zhuang D, et al. 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. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. 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. 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). z-index: 99; This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. #backTop { list-style-type: lower-alpha; For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. 2006;9(2):109-114. There were only 2 studies of a total 25 patients that were considered as good in quality. 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. 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. PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Ann Plastic Surg. 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 All RCTs that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. 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. 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. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. The Mammotome procedure represented another novel therapeutic option for gynecomastia. 1990;24(1):61-67. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Please check your insurance policy to see whether breast reduction is a covered procedure. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. 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. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. 2012;69(5):510-515. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. PDF Summary of Proposed Aetna Medicare Advantage Agreement Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Kasielska-Trojan A, Danilewicz M, Antoszewski B. 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 . Administration of Benefits and Transition Responsibilities Plastic Reconstr Surg. 2002;33:208-217. Reduction mammoplasty for macromastia. Ann Plast Surg. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. In a systematic review, these investigators examined the role of radiotherapy in this context. Yao Y, Yang Y, Liu J, et al. 2014a;34(1):66-73. 2005;58(3):286-289. Gland Surg. background-color:#eee; top: 0px; Hoyos AE, Perez ME, Dominguez-Millan R, et al. padding: 15px; No new trials were identified for this first update. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Policy. In these cases, breast reduction for men may take 2 to 3 hours. list-style-type: lower-roman; In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. 2007;36(2):497-519. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Management of gestational gigantomastia. 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. 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. 1997;185(6):593-603.
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