Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. 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). Treatment of adolescent gynecomastia. Major complications (1.6 %) included unilateral hematoma and localized infection. 2003;111(2):688-694. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. margin-bottom: 38px; Variations in pattern of pubertal changes in girls. (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. Ann Plastic Surg. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. 2016;20(3):256-260. 2011;128(4):243e-249e. For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. 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). This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. ul.ur li{ Plast Reconstr Surg. For medical In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Policy Statement 6d: Aesthetic surgery procedures. J Pediatr Surg. 1969;44(235):291-303. 2009;7(2):114-119. 1999;103(6):1674-1681. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Ann Plast Surg. --> 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). Plastic Reconstruct Surg. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Qu S, Zhang W, Li S, et al. 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. z-index: 99; These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. 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 effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. In a systematic review, these investigators examined the role of radiotherapy in this context. 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. 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). Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. This may lead to additional scarring and additional operating time. .headerBar { .newText { 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. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. 2014a;34(3):409-416. list-style-type: decimal; Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. The Breast: Comprehensive Management of Benign and Malignant Diseases. Priorities Forum Policy Statement. Policy. 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. Recommended criteria for insurance coverage of reduction mammoplasty. A total of 15 articles met the inclusion criteria for review. ASPS clinical practice guideline summary on reduction mammaplasty. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. These preliminary findings need to be validated by well-designed studies. Plast Reconstr Surg. J Plast Surg Hand Surg. The study subjects were stratified into groups based on ages of <60 years and 60 years. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). Level of Evidence = IV. In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. 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. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. } 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). Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. top: 0px; Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. The following procedures are considered experimental and investigational because there is insufficient evidence of itseffectiveness or itseffectiveness has not been established: Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. Ann Plast Surg. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. A follow-up study of 105 women with breast cancer following reduction mammaplasty. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. 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. 1995;34(2):113-116. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Autorino R, Perdona S, D'Armiento M, et al. Plast Reconstr Surg. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. } Aesthet Plastic Surg. 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 operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. However, it is unclear if there is any evidence to support this practice. The condition not only must be unresponsive to dermatological treatments (e.g., antibiotics or antifungal therapy) and conservative measures (e.g., good skin hygiene, adequate nutrition) for a period of 6 months or longer, but also must satisfy criteria stated insection I above. Please check your insurance policy to see whether breast reduction is a covered procedure. 2021;147(5):1072-1083. 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]). 2nd ed. Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). Plast Reconstr Surg. Fagerlund A, Lewin R, Rufolo G, et al. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Surg Laparosc Endosc Percutan Tech. The Mammotome procedure represented another novel therapeutic option for gynecomastia. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Annu Rev Med. 2021 Aug 11 [Online ahead of print]. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Aesthet Surg J. border-width:0; 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., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. Breast and aesthetic surgery. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. Gynaecomastia. Current concepts in gynaecomastia. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Evidence-based clinical practice guideline: Reduction mammaplasty. Socioeconomic Committee Position Paper. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Gynecomastia in patients with prostate cancer: A systematic review. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Reduction mammoplasty for asymptomatic members is considered cosmetic. 1998;26(1):61-65. Ann Plast Surg. Reduction mammaplasty: Defining medical necessity. To get insurance coverage, you'll probably need . Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. A population-level analysis of bilateral breast reduction: does age affect early complications? 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. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Reduction mammaplasty provides long-term improvement in health status and quality of life. 2019;8(4):431-440. Bertin ML, Crowe J, Gordon SM. Ages ranged from 18 to 66 years. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 1999;103(1):76-82; discussion 83-85. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. 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. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Bland KI, Copeland EM, eds. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. 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. 2018;7(Suppl 1):S70-S76. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 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. Oxfordshire NHS Trust. Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. Tang CL, Brown MH, Levine R, et al. Mizgala CL, MacKenzie KM. 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. 2007;356(5):479-485. 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). Little is known about the effect of surgical treatment on the psychological aspects of the disease. Hoyos AE, Perez ME, Dominguez-Millan R, et al. 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. 2017;139(6):1313-1322. 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. skin should not be excised horizontally below the inframammary fold. Aesthet Surg J. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Type II gynecomastia is more generalized breast enlargement. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Computed tomography scan of adrenal glands to identify adrenal lesions. list-style-type: upper-roman; Aesthetic Plast Surg. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis.
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