aetna breast reduction requirements

The health burden of breast hypertrophy. } Horm Res Paediatr. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Breast reduction for symptomatic macromastia. Ann Plast Surg. Oxford, UK: National Health Service (NHS); October 2008. Plast Reconstr Surg. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Level of Evidence = IV. 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. # color: white; From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. 1990;24(1):61-67. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. 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 . Can objective predictors for operative success be identified? Level of Evidence = IV. Recommended criteria for insurance coverage of reduction mammoplasty. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Gynecomastia has been classified into2 types. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. American Society of Plastic and Reconstructive Surgery (ASPRS). Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 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. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. 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. World J Surg. He Q, Zheng L, Zhuang D, et al. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Fagerlund A, Lewin R, Rufolo G, et al. 40 . list-style-type: upper-alpha; Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. 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. Surgery. } Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna No necrosis, systemic infection, or muscle paralysis was reported. 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). background: #5e9732; 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. @media print { Plast Reconstr Surg. Please check your insurance policy to see whether breast reduction is a covered procedure. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. 2009;62(2):195-199. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. border-radius: 4px; 2018;7(Suppl 1):S70-S76. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Scand J Plast Reconstr Hand Surg. 2009;19(3):e85-e90. } Schnur PL, Schnur DP, Petty PM, et al. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or Macromastia: all . Oxfordshire NHS Trust. Plastic surgery for teenagers briefing paper. Obstet Gynecol Clin North Am. For many patients the psychological impact of the disease is substantial. 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. of the following criteria must be met: Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. The authors stated that operative subjects were told that their responses to the questionnaire were not to be used for insurance and thus the subjects had no motivation to exaggerate symptoms prior to surgery in questionnaire responses; however, it is not clear whether operative subjects would be willing to submit responses to a questionnaire from the doctor that differed substantially from the history that they provided to the doctor during their preoperative evaluation. Policy Statement 6d: Aesthetic surgery procedures. In: Townsend CM, Beuchamp RD, Evers BM, eds. Arlington Heights, IL: ASPS; May 2011. Plastic Reconstruct Surg. Level of Evidence = IV. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. cursor: pointer; 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. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Aesthet Surg J. Petty PM, Solomon M, Buchel EW, Tran NV. A population-level analysis of bilateral breast reduction: does age affect early complications? 2006;118(4):840-848. Plastic Reconstruct Surg. 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. Last Review01/04/2023. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. 2002;33:208-217. Brown DM, Young VL. color: red For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). 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). Washington, DC: ACOG; 2011:121-122. 2014b;48(5):334-339. OL OL OL OL OL LI { Bland KI, Copeland EM, eds. Plast Reconstr Surg. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. 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. ul.ur li{ Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Reduction mammoplasty for asymptomatic members is considered cosmetic. 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). 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. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. padding-bottom: 4px; margin-bottom: 38px; Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. 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 . Mental health care professionals may be consulted to address psychological distress from gynecomastia. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. All patients underwent routine investigations to exclude secondary causes of gynecomastia. 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. And if you are in Canada the surgeon decides. A total of 81 patients were included in this study. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note Reduction mammaplasty: Defining medical necessity. 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. 2010;45(3):650-654. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. 2002;109(5):1556-1566. ASPS clinical practice guideline summary on reduction mammaplasty. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. 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). background-color:#eee; Plast Reconstr Surg. 2008;61(5):493-502. Surgical management of gynecomastia--a 10-year analysis. 2 . 1998;49:215-234. Qu S, Zhang W, Li S, et al. Seitchik MW. Treatment of adolescent gynecomastia. 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. 2015;75(4):370-375. 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. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Also, there was no correlation between PR expression and 2D: 4D. .newText { What are Aetna breast reduction requirements? - RealSelf.com The Breast: Comprehensive Management of Benign and Malignant Diseases. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 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. Level of Evidence = III. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 2015;10(8):e0136094. These investigators searched the literature on the treatment of Simon's grade I and II gynecomastia in PubMed, Scopus, Science Direct, and Cochrane using keywords "gynecomastia" and "liposuction". Raispis T, Zehring RD, Downey DL. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Long-term functional results after reduction mammoplasty. Miller AP, Zacher JB, Berggren RB, et al. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. border: none; Hoyos AE, Perez ME, Dominguez-Millan R, et al. Ann Plast Surg. Major complications (1.6 %) included unilateral hematoma and localized infection. text-decoration: line-through; ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). 2014a;34(1):66-73. Tang CL, Brown MH, Levine R, et al. Kalliainen LK; ASPS Health Policy Committee. 1991;27(3):232-237. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Three review authors undertook independent screening of the search results. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. 2004;113(1):436-437. Schnur PL, Hoehn JG, Ilstrup DM, et al. Gynecomastia in patients with prostate cancer: Update on treatment options. list-style-type: upper-roman; 2000;106(5):991-997. 1993;17(3):211-223. 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).