} Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an out-patient; however, this was not statistically significant (p = 0.07). Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. 2012;130(4):785-789.
CG-SURG-71 Reduction Mammaplasty - Anthem Breast and aesthetic surgery. Aesthetic Plast Surg. 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: Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). OL OL LI { cursor: pointer; 2 . For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. All the patients recovered well and were satisfied with the cosmetic outcomes. Type II gynecomastia is more generalized breast enlargement. 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. background-color: #cc0066; In other patients, excess skin and nipple and areola relocation are necessary. 1991;27(3):232-237. PLoS One. 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. 18th ed. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.)
What are Aetna breast reduction requirements? - RealSelf.com Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 1999;103(6):1682-1686. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. width: 100%; 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. Three review authors undertook independent screening of the search results. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia).
PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna Arlington Heights, IL: ASPS; March 9, 2002. Long-term functional results after reduction mammoplasty. Breast J. Reduction mammaplasty: A review of managed care medical policy coverage criteria. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Reduction mammoplasty for asymptomatic members is considered cosmetic. 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). Gland Surg. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. See Appendix for Table 1. ul.ur li{ 2015;49(6):363-366. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). Gland Surg. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Other just require 500 grams no matter what your height and weight. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). 01/04/2023 1990;24(1):61-67. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. of . Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Operative subjects who completed the study reported reductions in pain and improvements in quality of life; however, these improvements may be attributable to placebo effects, the natural history of back pain, other concurrent interventions, regression to the mean, improvements in cosmesis (for quality of life measures), or other confounding variables that may bias in interpretation of results. 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 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%. Ann Plast Surg. Seitchik MW. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. Handschin AE, Bietry D, Hsler R, et al. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. @media print { Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. No statistically significant differences in the drainage, level of pain, size of open areas, clinical appearance, degree of scar pliability, or scar erythema were noted. Oxfordshire NHS Trust. 2017;139(6):1313-1322. 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? } It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Ann Plast Surg. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. 2014a;34(1):66-73. /*margin-bottom: 43px;*/ Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. Computed tomography scan of adrenal glands to identify adrenal lesions. The authors (Nguyen et al, 2004) argue, based primarily on the results of the ASPS-funded BRAVO study (described below), that (with a single exception) no objective criteria for breast reduction surgery are supportable, including criteria based upon the presence of particular signs or symptoms, requirements based upon breast size or the amount of breast tissue removed, any minimum age limitations, any limitation based upon maximum body weight, requirements for a trial of conservative therapy, or the exclusion of certain procedures (liposuction). } The risks included infection, wound breakdown, scarring, and the need for re-operating. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. The end-point was the complete resolution of gynecomastia. 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. 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 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. 2007;36(2):497-519.
PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Copyright Aetna Inc. All rights reserved. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients.
Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note 2021 Aug 11 [Online ahead of print]. 2021;147(5):1072-1083. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Gynecomastia. background-position: right 65%; cursor: pointer; 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. 2021;74(11):3128-3140. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). 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). 2001;107(5):1234-1240. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Administration of Benefits and Transition Responsibilities The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. OL LI { 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". 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. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Many men with breast enlargement are found to have pseudo-gynecomastia. The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition.
Breast Reduction | American Society of Plastic Surgeons Is breast reduction covered by health insurance? | ASPS Laituri CA, Garey CL, Ostlie DJ, et al. } 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Philadelphia, PA: W.B. The member has gigantomastia of pregnancy accompanied byany of the following complications, and delivery is not imminent: For medical necessity criteria for surgery to correct breast asymmetry, seeCPB 0185 - Breast Reconstructive Surgery.
Breast reduction surgery - Mayo Clinic The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. color: red background: #5e9732;
PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com background-color:#eee; Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. American Society of Plastic and Reconstructive Surgery (ASPRS). skin should not be excised horizontally below the inframammary fold. } 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. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Macromastia: all . 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. Another set of breast pump supplies if you get pregnant . # color: white; 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. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Asian J Surg. 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). Breast hypertrophy.
Breast Reduction Surgery | Johns Hopkins Medicine Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. padding: 10px; No data were provided on loss to follow-up. 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. 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. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Araco A, Gravante G, Araco F, et al. ol.numberedList LI { 2004;113(1):436-437. Breast reduction outcome study. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. There were 18 out of 415 studies eligible to review. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction.
Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Plastic Reconstruct Surg. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Plast Reconstr Surg. display: none; Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies.