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. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare 2002;109(5):1556-1566. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Plastic Reconstr Surg. Other just require 500 grams no matter what your height and weight. 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]). Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. CG-SURG-71 Reduction Mammaplasty - Anthem 1999;103(6):1674-1681. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Policy. Hoyos AE, Perez ME, Dominguez-Millan R, et al. Brown MH, Weinberg M, Chong N, et al. He Q, Zheng L, Zhuang D, et al. Ann Plast Surg. cursor: pointer; The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. 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. Collis N, McGuiness CM, Batchelor AG. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. 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. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . Level of Evidence = III. ol.numberedList LI { Narula HS, Carlson HE. 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). Sood R, Mount DL, Coleman JJ 3rd, et al. 1998;41(3):240-245. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. Treating providers are solely responsible for medical advice and treatment of members. 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: Ann Plast Surg. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. 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). 2019;166(5):934-939. color: white; } 2021;147(5):1072-1083. 1995;61(11):1001-1005. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. OL LI { Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Glatt BS, Sarwer DB, O'Hara DE, et al. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. 1996;20(5):391-397. 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. However, these medications should be reserved for those with no decrease in breast size after 2 years. 2015;75(4):383-387. Follow-up ranged from 2 months to 3 years. Gonzalez FG, Walton RL, Shafer B, et al. The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. Level of Evidence = IV. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor 2015;49(6):363-366. American Society of Plastic and Reconstructive Surgery (ASPRS). American Society of Plastic Surgeons (ASPS). All patients underwent routine investigations to exclude secondary causes of gynecomastia. ASPS Recommended Coverage Criteria for Third Party Payors. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. Risk of bias was assessed independently by 2review authors. 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). Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Breast Reduction | American Society of Plastic Surgeons font-size: 18px; height:2px; Principles of breast re-reduction: A reappraisal. 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? 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. Annu Rev Med. 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. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. text-decoration: line-through; Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. 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. Arlington Heights, IL: ASPS; 2011. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. The average age was 24.7 years (range of 18 to 47 years). 2 . Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . } Mayo Clin Proc. 2014;20(3):274-278. 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. Plast Reconstr Surg. Surgeon. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). 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. Fischer JP, Cleveland EC, Shang EK, et al. 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. OL OL OL OL OL LI { skin should not be excised horizontally below the inframammary fold. 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. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. American Society of Plastic Surgeons (ASPS). Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. 40 . Araco A, Gravante G, Araco F, et al. Can objective predictors for operative success be identified? Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. 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. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. } Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. No other operation-related complications were observed. 2004;113(1):436-437. Surgical treatment is indicated when medical treatments fail. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). 1999;103(6):1682-1686. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). 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). list-style-type: decimal; .fixedHeaderWrap { The Mammotome procedure represented another novel therapeutic option for gynecomastia. 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. No new trials were identified for this first update. Marshall WA, Tanner JM. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Breast cancer found at the time of breast reduction. Surgical management of gynecomastia--a 10-year analysis. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Variations in pattern of pubertal changes in girls. } 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. bottom: 20px; These preliminary findings need to be validated by well-designed studies. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Ann Plast Surg. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the PLoS One. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. 2014b;48(5):334-339. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. 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. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. 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. Karamanos et al (2015) identified their study as the largest sample on breast reduction in the literature, in which age and surgeon specialty did not correlate with negative results. right: 30px; Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. 2006;30(3):309-319. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Plastic Reconstruct Surg. 18th ed. Rising Rates of Insurance Denial for Breast Reduction Surgery The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. Collins ED, Kerrigan CL, Kim M, et al. OL OL LI { Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Patients with abnormal histopathology could not be pre-operatively identified based on demographics. 2009;62(2):195-199. To get insurance coverage, you'll probably need . Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna 2015;75(4):370-375. 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. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. @media print { Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Raispis T, Zehring RD, Downey DL. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. Am Surg. Ann Plast Surg. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Breast reduction surgery - Mayo Clinic 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). Plast Reconstr Surg. 2002;33:208-217. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. 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 asymmetries: A brief review and our experience. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Breast hypertrophy. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Kerrigan CL, Collins ED, Kim HM, et al. In other patients, excess skin and nipple and areola relocation are necessary. See Appendix for Table 1. Gland Surg. The mean age was 42.8 years (SD 19.5 years). From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. This may lead to additional scarring and additional operating time. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna Fagerlund A, Lewin R, Rufolo G, et al. Links to various non-Aetna sites are provided for your convenience only. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Ann Plastic Surg. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. --> 2009;7(2):114-119. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. 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). PDF Gender Dysphoria Treatment - Cigna Surgical treatment of gynecomastia: Complications and outcomes. When seeking preauthorization for a breast reduction, your goal is generally twofold. Many men with breast enlargement are found to have pseudo-gynecomastia. Plast Reconstr Surg. Reduction mammaplasty provides long-term improvement in health status and quality of life. There were only 2 studies of a total 25 patients that were considered as good in quality. Qu S, Zhang W, Li S, et al. Sabistons Textbook of Surgery (Burns & Blackwell, 2008)states that breast size should be stable for one year: There is no set lower age limit but, for the adolescent with breast hypertrophy, reduction is deferred until the breasts have stopped growing and are stable in size for at least 12 months before surgery.. 2015;(10):CD007258. (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. 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. Schnur et al (1991) reported on a sliding scale assigns a weight of breast tissue to be removed based on body weight and surface area. Kasielska-Trojan A, Danilewicz M, Antoszewski B. # color: white; Plast Reconstr Surg. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. list-style-type: decimal; Miller AP, Zacher JB, Berggren RB, et al. 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. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Mistry RM, MacLennan SE, Hall-Findlay EJ. 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. Well-designed clinical trials provide reliable information about the effectiveness of an intervention, and provide valid information about the characteristics of patients who would benefit from that intervention. cursor: pointer; 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. 1. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. 2021;74(11):3128-3140. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. Gynaecomastia. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. There were no restrictions on the basis of date or language of publication. Computed tomography scan of adrenal glands to identify adrenal lesions. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. } border-radius: 4px; Surg Laparosc Endosc Percutan Tech. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. 2003;111(2):688-694. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery.
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