Miller AP, Zacher JB, Berggren RB, et al. J Plast Reconstr Aesthet Surg. 2014a;34(1):66-73. Kerrigan CL, Collins ED, Striplin D, et al. Subjects were compared to age-matched norms from another study cohort. 2006;118(4):840-848. @media print { Priorities Forum Policy Statement. N Engl J Med. 2012;130(4):785-789. This will be computed based on your body area. margin-bottom: 38px; The end-point was the complete resolution of gynecomastia. Br J Plast Surg. Ann Plast Surg. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. 2006;9(2):109-114. 1990;24(1):61-67. Breast asymmetries: A brief review and our experience. 2015;10(8):e0136094. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Handschin AE, Bietry D, Hsler R, et al. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. 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). Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Townsend: Sabiston Textbook of Surgery. ASPS Recommended Coverage Criteria for Third Party Payors. 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). Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. list-style-type: lower-alpha; Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). 1969;44(235):291-303. 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. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Long-term functional results after reduction mammoplasty. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. Arch Dis Child. Fagerlund A, Cormio L, Palangi L, et al. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Variations in pattern of pubertal changes in girls. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). PDF Summary of Proposed Aetna Medicare Advantage Agreement Determinants of surgical site infection after breast surgery. 2014;20(3):274-278. border-radius: 4px; 2001;108(6):1591-1599. Gonzalez FG, Walton RL, Shafer B, et al. Kalliainen LK; ASPS Health Policy Committee. OL LI { 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. In a systematic review, these investigators examined the role of radiotherapy in this context. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. Women's Health and Cancer Rights Act of 1998. Reduction mammoplasty for macromastia. The mean volume of tissue resected was 250 g (range of 22 to 758 g) from the right breast and 244 g (range of 15 to 705 g) from the left breast. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). When seeking preauthorization for a breast reduction, your goal is generally twofold. Prostate Cancer Prostatic Dis. list-style-type : square !important; 1999;103(6):1674-1681. 40 . A follow-up study of 105 women with breast cancer following reduction mammaplasty. Surgical treatment of gynecomastia: Complications and outcomes. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. Kerrigan CL, Collins ED, Kneeland TS, et al. PDF Procedures, programs and drugs you must precertify - AmeriBen Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. Saunders Co.; 1991. 1996;20(5):391-397. } Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. There were no restrictions on the basis of date or language of publication. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. 2000;44(2):125-134. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. } 2008;32(1):38-44. Risk of bias was assessed independently by 2review authors. background: #5e9732; Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Tang CL, Brown MH, Levine R, et al. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Reduction mammoplasty improves symptoms of macromastia. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. OL OL LI { It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 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. Ann Plast Surg. However, these medications should be reserved for those with no decrease in breast size after 2 years. of the following criteria must be met: 2001;108(1):62-67. 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). Gynecomastia may be drug-induced. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Well-designed trials are especially important in assessing pain management interventions to isolate the contribution of the intervention from placebo effects, the effects of other concurrently administered pain management interventions, and the natural history of the medical condition. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. No author listed. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. background-color: #cc0066; Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. 2009;62(2):195-199. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. 01/04/2023 Plast Reconstr Surg. A cohort study of breast cancer risk in breast reduction patients. Level of Evidence = IV. cursor: pointer; Breast pumps. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. 2007;356(5):479-485. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Obstet Gynecol Clin North Am. 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. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. }. color: blue!important; 1998;26(1):61-65. Other just require 500 grams no matter what your height and weight. PLoS One. Nelson et al (2014b) separately conducted a population level analysis of the 2005-2011 NSQIP datasets, identifying patient who underwent reduction mammoplasty, to determine the impact of obesity on early complications after reduction mammoplasty. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Breast and aesthetic surgery. Ann Plast Surg. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Ann Plast Surg. Brown MH, Weinberg M, Chong N, et al. 2nd ed. Breast Reduction | American Society of Plastic Surgeons A population-level analysis of bilateral breast reduction: does age affect early complications? In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Brown DM, Young VL. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Mizgala CL, MacKenzie KM. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Plast Reconstr Surg. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Ann Chir Plast Esthet. American Society of Plastic Surgeons (ASPS). Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . 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. Plast Reconstr Surg. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. How to make Aetna pay for your breast reduction surgery Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Aesthetic Plast Surg. 2021 Aug 11 [Online ahead of print]. 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. Surg Laparosc Endosc Percutan Tech. Abnormalities in Adolescent Breast Development. Aetna considers magnetic resonance imaging (MRI), with or without contrast materials, of the breast medically necessary for members who have had a recent (within the past year) conventional mammogram and/or breast sonogram, in any of the following circumstances where MRI of the breast may affect their clinical management:. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). --> # color: white; In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. CG-SURG-71 Reduction Mammaplasty - Anthem The majority (87.7 %) of cases presented with accompanying mastalgia. Fagerlund A, Lewin R, Rufolo G, et al. 2016;20(3):256-260. 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). Gland Surg. Rising Rates of Insurance Denial for Breast Reduction Surgery Plast Reconstr Surg. Fischer S, Hirsch T, Hirche C, et al. 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). 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. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. In the case of breast reduction, however, for insurance purposes, it . Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. 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". This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Gynaecomastia. Devalia HL, Layer GT. This investigators stated that these studies should include data from older individuals affected by gynecomastia and utilize valid tools of psychological measurement in order to better quantify the effect; elderly patients affected by the disease have been over-looked in the current research; more data on this subject could improve the pre-operative evaluation of these patients and help identify the patients who will benefit from treatment. 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. Am J Infect Control. 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. } Breast hypertrophy. Gynecomastia is a very common concern of male adolescence. Plast Reconstr Surg. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). 2011;128(4):243e-249e. ol.numberedList LI { J Plast Reconstr Aesthet Surg. 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. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Bertin ML, Crowe J, Gordon SM. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. 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. 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. Please check your insurance policy to see whether breast reduction is a covered procedure. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. The Mammotome procedure represented another novel therapeutic option for gynecomastia. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. 1994;21(3):539-543. Ann Plastic Surg. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. 2008;53(3):255-261. OL OL OL OL OL LI { However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Plastic Reconstr Surg. } Mistry RM, MacLennan SE, Hall-Findlay EJ. 2010;45(3):650-654. This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. For medical 2018;7(Suppl 1):S70-S76. 2015;49(6):363-366. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Magnetic Resonance Imaging (MRI) of the Breast - Aetna J Pediatr Surg. Plast Reconstr Surg. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Reduction mammoplasty for asymptomatic members is considered cosmetic.