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J Plast Reconstr Aesthet Surg. 2000;106(5):991-997. 2015;49(6):311-318. Brown MH, Weinberg M, Chong N, et al. } PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com outline: none; Long-term functional results after reduction mammoplasty. 1997;100(4):875-883. color: blue!important; However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. There were 18 out of 415 studies eligible to review. /* aetna.com standards styles for templates */ Mistry RM, MacLennan SE, Hall-Findlay EJ. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. 2002;109(5):1556-1566. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. 2004;113(1):436-437. 2011;128(4):243e-249e. A cohort study of breast cancer risk in breast reduction patients. Obesity and complications in breast reduction surgery: Are restrictions justified? 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). 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. 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. Ann Plast Surg. 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. Mayo Clin Proc. Plast Reconstr Surg. 18th ed. 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. 2009;19(3):e85-e90. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Resolution of idiopathic gynecomastia may take several months to years. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Breast reduction outcome study. 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 Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. 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]. list-style-type : square !important; Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass N Engl J Med. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. 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). Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. Risk of bias was assessed independently by 2review authors. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. A non-standardized survey showed a very high satisfaction index. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Plast Reconstr Surg. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Current concepts in gynaecomastia. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Ann Plast Surg. Plast Reconstr Surg. OL LI { Sugrue CM, McInerney N, Joyce CW, et al. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. li.bullet { 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. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Surg Laparosc Endosc Percutan Tech. Plastic Reconstr Surg. margin-bottom: 38px; Laituri CA, Garey CL, Ostlie DJ, et al. PDF Procedures, programs and drugs you must precertify - AmeriBen Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. .arrowPurpleSmall, a:hover.arrowPurpleSmall { #backTop { 2007;356(5):479-485. Plast Reconstr Surg. Plast Reconstr Surg. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. 1998;26(1):61-65. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. 2015;(10):CD007258. Arlington Heights, IL: ASPRS; 1987. GP Notebook. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. border: none; z-index: 99; The Breast: Comprehensive Management of Benign and Malignant Diseases. 2021;74(11):3128-3140. top: 0px; Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. } } There were no restrictions on the basis of date or language of publication. hr.separator { Level of Evidence = IV. bottom: 20px; The nipple-areola complex was re-positioned in 60 % of patients (n = 54). All studies on the subject were evaluated for inclusion and 6 studies were included in the review. 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. Ann Plast Surg. 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. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Kalliainen LK; ASPS Health Policy Committee. 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. 2018;7(Suppl 1):S70-S76. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). 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. 2016;20(3):256-260. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. (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. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. skin should not be excised horizontally below the inframammary fold. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the 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. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. 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 . Breast Reduction Surgery | Johns Hopkins Medicine 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]). Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. As explained below, 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. text-decoration: underline; Does Health Insurance Cover Breast Reduction Surgery? - GoodRx High-risk lesions (atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], and lobular carcinoma in situ [LCIS]) were revealed in 37 (11.7 %), and cancer in 6 (1.9 %) patients. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. 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. @media print { Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. The authors concluded that breast re-reduction can be performed safely and predictably, even when the previous technique is not known; and 4 key principles were developed: Language services can be provided by calling the number on your member ID card. There were only 2 studies of a total 25 patients that were considered as good in quality. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Priorities Forum Policy Statement. 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. color: red Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Br J Plast Surg. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Major complications (1.6 %) included unilateral hematoma and localized infection. Breast J. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Horm Res Paediatr. A systematic search of the published literature was performed. Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. 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. Handschin AE, Bietry D, Hsler R, et al. 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. /*margin-bottom: 43px;*/ Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne 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. 2002;33:208-217. Gland Surg. No other operation-related complications were observed. 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. 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: 2014;20(3):274-278. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. 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. 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. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Reduction mammaplasty. Am J Infect Control. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Kerrigan CL, Collins ED, Striplin D, et al. color: red!important; 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. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Reduction mammaplasty: Defining medical necessity. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). Socioeconomic Committee Position Paper. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Arlington Heights, IL: ASPS; 2011. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Grooving where the bra straps sit on the shoulder. Breast and aesthetic surgery. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Breast hypertrophy. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. }. 2001;107(5):1234-1240. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. 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 PLoS One. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna 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. ASPS clinical practice guideline summary on reduction mammaplasty. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. Another set of breast pump supplies if you get pregnant . .newText { Brown DM, Young VL. 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. position: fixed; } Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Refer to the member's specific plan document for applicable coverage. Oxford, UK: National Health Service (NHS); October 2008. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. 2014a;34(1):66-73. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. All the patients recovered well and were satisfied with the cosmetic outcomes. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Plast Reconstr Surg. J Am Coll Surg. Subjects were compared to age-matched norms from another study cohort. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. 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. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). J Laparoendosc Adv Surg Tech A. text-decoration: line-through; Level of Evidence = III. If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. 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. These preliminary findings need to be validated by well-designed studies. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. background-color:#eee; Arlington Heights, IL: ASPS; May 2011. To get insurance coverage, you'll probably need . 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. Please check your insurance policy to see whether breast reduction is a covered procedure. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Policy. Am Surg. Furthermore, the lack of an expected "dose-response" relationship between the amount of breast tissue removed and the magnitude of symptomatic relief in these studies raises questions about the validity of these studies and the effectiveness of breast reduction as a method of relieving shoulder and back pain. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? 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). ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Breast cancer found at the time of breast reduction.