Breast and aesthetic surgery. 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. 1998;49:215-234. and areola. Mistry RM, MacLennan SE, Hall-Findlay EJ. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. CG-SURG-71 Reduction Mammaplasty - Anthem (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) 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 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. Endocrinol Metab Clin North Am. Level of Evidence = III. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. cursor: pointer; Gynecomastia. 2 . Breast J. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. Other just require 500 grams no matter what your height and weight. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. 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 . Aesthetic Plast Surg. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. cursor: pointer; 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. In: Townsend CM, Beuchamp RD, Evers BM, eds. A population-level analysis of bilateral breast reduction: does age affect early complications? 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. Qu S, Zhang W, Li S, et al. } 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. Kasielska-Trojan A, Danilewicz M, Antoszewski B. 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 If an insufficient amount of breast tissue is removed, the surgery is less likely to be successful in relieving pain and any related symptoms from excessive breast weight (e.g., excoriations, rash). Ann Plast Surg. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. background: #5e9732; From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Pain/discomfort/ulceration from bra straps cutting into shoulders; Skin breakdown (severe soft tissue infection, tissue necrosis, ulceration hemorrhage) from overlying breast tissue; There is a reasonable likelihood that the member's symptoms are primarily due to macromastia; Reduction mammoplasty (also spelled as 'mammaplasty') is likely to result in improvement of the chronic pain; Pain symptoms persist as documented by the physician despite at least a 3-month trial of therapeutic measures such as: Analgesic/non-steroidal anti-inflammatory drugs (NSAIDs) interventions and/or muscle relaxants, Dermatologic therapy of ulcers, necrosis and refractory infection, Physical therapy/exercises/posturing maneuvers, Supportive devices (e.g., proper bra support, wide bra straps), Chiropractic care or osteopathic manipulative treatment. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Recommended criteria for insurance coverage of reduction mammoplasty. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 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]. What are Aetna breast reduction requirements? - RealSelf.com Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. } Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. background-color:#eee; Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. 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. 2019;166(5):934-939. Philadelphia, PA: W.B. 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. 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. 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. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. Med Decis Making. Scand J Plast Reconstr Hand Surg. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. 1. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. } color:#eee; 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). Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. 2015;10(8):e0136094. } Plast Reconstr Surg. Principles of breast re-reduction: A reappraisal. What can I do if my insurance denies coverage for breast reduction? Annu Rev Med. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. 1995;95(1):77-83. In addition, Nguyen et al (2004) ignored a wealth of published evidence of the effectiveness of physical therapy, analgesics and other conservative measures on back and neck pain generally. OL OL OL OL LI { 2001;76(5):503-510. font-size: 18px; J Plast Surg Hand Surg. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Reduction mammoplasty for asymptomatic members is considered cosmetic. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. 2001;108(1):62-67. And if you are in Canada the surgeon decides. /*margin-bottom: 43px;*/ 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. Plastic Reconstruct Surg. 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. A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammoplasty regarding physical symptoms and body image. Breast J. 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 . Oxfordshire NHS Trust. 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. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. American Society of Plastic and Reconstructive Surgery (ASPRS). Follow-up ranged from 2 months to 3 years. Well-designed trials are especially important in assessing pain management interventions to isolate the contribution of the intervention from placebo effects, the effects of other concurrently administered pain management interventions, and the natural history of the medical condition. Grooving where the bra straps sit on the shoulder. For many patients the psychological impact of the disease is substantial. Pediatr Surg Int. 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. Arlington Heights, IL: ASPS; May 2011. 2007;356(5):479-485. Lonie S, Sachs R, Shen A, et al. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. 2005;58(3):286-289. 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. How to make Aetna pay for your breast reduction surgery Treating providers are solely responsible for medical advice and treatment of members. 2001;108(6):1591-1599. outline: none; These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. 2007;36(2):497-519. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. # color: white; Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Aesthet Surg J. Plast Reconstr Surg. Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years). See Appendix for Table 1. padding-right: 18px; There were only 2 studies of a total 25 patients that were considered as good in quality. Gynecomastia: A systematic review. li.bullet { Quality of life after breast reduction. Surgical treatment of primary gynecomastia in children and adolescents. Prepubertal gynecomastia linked to lavender and tea tree oils. 2009;7(2):114-119. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. width: 100%; Although the BRAVO study nominally included a "control group", there was no comparison group of subjects selected from the same cohort, who were randomized or otherwise appropriately assigned to reduce bias, and treated with conservative management according to a protocol to ensure optimal conservative care. The health burden of breast hypertrophy. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. Arlington Heights, IL: ASPRS; 1987. Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. Fischer S, Hirsch T, Hirche C, et al. Brown MH, Weinberg M, Chong N, et al. There were 18 out of 415 studies eligible to review. Collis N, McGuiness CM, Batchelor AG. color: red Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna 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. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Plastic Reconstruct Surg. Level of Evidence = IV. 1997;100(4):875-883. } J Plast Reconstr Aesthet Surg. 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. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Schnur PL, Hoehn JG, Ilstrup DM, et al. 2018;89(6):408-412. Aesthet Plastic Surg. This may lead to additional scarring and additional operating time. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Aesthetic Plast Surg. 2007;119(4):1159-1166. 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. 1990;24(1):61-67. } Note: Chronic intertrigo, eczema, dermatitis, and/or ulceration in the infra-mammary fold in and of themselves are not considered medically necessary indications for reduction mammoplasty. padding-bottom: 4px; 2013;71(5):471-475. Mayo Clin Proc. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Gynaecomastia. 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.