A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Arch Dis Child. 2014b;30(6):641-647. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. 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. Aesthetic Plast Surg. Level of Evidence = III. Asian J Surg. Variations in pattern of pubertal changes in girls. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. The risks included infection, wound breakdown, scarring, and the need for re-operating. A total of 90 patients underwent breast re-reduction surgery. Breast pumps. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. A cohort study of breast cancer risk in breast reduction patients. Handschin AE, Bietry D, Hsler R, et al. z-index: 99; display: none; 2014a;34(1):66-73. 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. 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: 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Thus, more than 1/3of operative subjects selected for inclusion in the study did not complete it; most of the operative subjects who did not complete the study were lost to follow-up. Fischer S, Hirsch T, Hirche C, et al. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare What are Aetna breast reduction requirements? - RealSelf.com A total of 182 thirty-day postoperative surgical complications were documented, but stratifying patients into 2 age groups did not reveal an association between age and any surgical complication (P = .26). 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? } A non-standardized survey showed a very high satisfaction index. Plast Reconstr Surg. Araco A, Gravante G, Araco F, et al. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Brown DM, Young VL. Computed tomography scan of adrenal glands to identify adrenal lesions. A detailed physical examination, including testicular examination. hr.separator { 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 reduction surgery is considered cosmetic for all indications not listed in section I, A. display: block; In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Macromastia: all . 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. list-style-type: decimal; 2009;7(2):114-119. Lonie S, Sachs R, Shen A, et al. 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. padding: 10px; PDF A look at new changes coming to E&M and breast coding in 2021 Miller AP, Zacher JB, Berggren RB, et al. of the following criteria must be met: 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. 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. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. 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. Ann Plast Surg. Treatment of adolescent gynecomastia. 1998;26(1):61-65. Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 1995;61(11):1001-1005. 2017;139(6):1313-1322. } Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. 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 2015;10(8):e0136094. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna @media print { Plast Reconstr Surg. Often times, insurance company will dictate how much breast tissue to be removed. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. Endocrinol Metab Clin North Am. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. 01/04/2023 The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Ann Plast Surg. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Surgical management of gynecomastia--a 10-year analysis. Also, there was no correlation between PR expression and 2D: 4D. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). 2017;35:157-161. 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. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Breast and aesthetic surgery. text-decoration: line-through; Oxford, UK: National Health Service (NHS); October 2008. 2000;45(6):575-580. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the 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). Other just require 500 grams no matter what your height and weight. A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. Sugrue CM, McInerney N, Joyce CW, et al. Raispis T, Zehring RD, Downey DL. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. 1998;41(3):240-245. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Breast J. Gynecomastia in patients with prostate cancer: A systematic review. 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. No other operation-related complications were observed. 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 The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Breast Concerns of Adolescents. } J Am Coll Surg. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Administration of Benefits and Transition Responsibilities Ann Plast Surg. Ann Plast Surg. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Ages ranged from 18 to 66 years. J Plast Surg Hand Surg. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. 1995;95(1):77-83. 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). Nguyen JT, Wheatley MJ, Schnur PL, et al. Plast Reconstr Surg. Collins ED, Kerrigan CL, Kim M, et al. Khan SM, Smeulders MJ, Van der Horst CM. Another set of breast pump supplies if you get pregnant . 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). padding: 15px; Little is known about the effect of surgical treatment on the psychological aspects of the disease. Ann Plast Surg. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. 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. 2008;53(3):255-261. Surgeon. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. This may lead to additional scarring and additional operating time. 2018;24(6):1043-1045. Plastic surgery for teenagers briefing paper. Emiroglu M, Salimoglu S, Karaali C, et al. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. 2006;30(3):309-319. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. 2019;166(5):934-939. J Plast Reconstr Aesthet Surg. 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. 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. 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. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. Breast reduction surgery - Mayo Clinic 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. Plast Reconstr Surg. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. The average age was 24.7 years (range of 18 to 47 years). Breast asymmetries: A brief review and our experience. 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. In other patients, excess skin and nipple and areola relocation are necessary. Yao Y, Yang Y, Liu J, et al. Philadelphia, PA: W.B. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. 2016;20(3):256-260. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Current concepts in gynaecomastia. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Plast Reconstr Surg. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. 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). Please check your insurance policy to see whether breast reduction is a covered procedure. 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. Gynecomastia. background-position: right 65%; 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.

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