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. Fagerlund A, Cormio L, Palangi L, et al. 2006;9(2):109-114. 2005;58(3):286-289. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. See Appendix for Table 1. Arlington Heights, IL: ASPS; March 9, 2002. Tang CL, Brown MH, Levine R, et al. Surg Laparosc Endosc Percutan Tech. 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.. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. 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. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. In other patients, excess skin and nipple and areola relocation are necessary. 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. Reduction mammoplasty: Cosmetic or reconstructive procedure? 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. color: red 2008;121(4):1092-1100. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. list-style-type: decimal; 2013;71(5):471-475. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. A systematic search of the published literature was performed. Gynecomastia is a very common concern of male adolescence. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Fagerlund A, Lewin R, Rufolo G, et al. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Lonie S, Sachs R, Shen A, et al. Follow-up ranged from 2 months to 3 years. What are Aetna breast reduction requirements? - RealSelf.com Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. } These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Schnur PL, Schnur DP, Petty PM, et al. 2000;45(6):575-580. Risk of bias was assessed independently by 2review authors. Breast cancer found at the time of breast reduction. 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. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. 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. Does Aetna Cover Breast Reduction? | HelpAdvisor.com Seitchik MW. There were 18 out of 415 studies eligible to review. 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. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. 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. ul.ur li{ Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. 1997;185(6):593-603. Abnormalities in Adolescent Breast Development. J Pediatr Surg. Ann Plastic Surg. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. PDF 0185 Breast Reconstructive Surgery (1) - Aetna Breast reduction outcome study. 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". Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Plast Reconstr Surg. Ages ranged from 18 to 66 years. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Kerrigan CL, Collins ED, Kneeland TS, et al. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. display: none; The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. How to Get Your Breast Reduction Covered By Insurance - RealSelf News It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. hr.separator { Coding In: Townsend CM, Beuchamp RD, Evers BM, eds. 1999;103(6):1674-1681. He Q, Zheng L, Zhuang D, et al. Current concepts in gynaecomastia. Other just require 500 grams no matter what your height and weight. 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. 2006;30(3):309-319. The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. Kalliainen LK; ASPS Health Policy Committee. Magnetic Resonance Imaging (MRI) of the Breast - Aetna A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) This may lead to additional scarring and additional operating time. 40 . Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. A non-standardized survey showed a very high satisfaction index. } PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Type II gynecomastia is more generalized breast enlargement. } 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). } 2002;33:208-217. breast augmentation with implant. } In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. 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. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. /* aetna.com standards styles for templates */ Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Analysis was on an intention-to-treat basis. 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. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). J Plast Reconstr Aesthet Surg. Plast Reconstr Surg. The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Sood R, Mount DL, Coleman JJ 3rd, et al. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. 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. Is breast reduction covered by health insurance? | ASPS list-style-type: upper-alpha; If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. 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). 2012;130(4):785-789. Aetna considers breast reconstructive surgery to correct The authors (Nguyen et al, 2004) argue, based primarily on the results of the ASPS-funded BRAVO study (described below), that (with a single exception) no objective criteria for breast reduction surgery are supportable, including criteria based upon the presence of particular signs or symptoms, requirements based upon breast size or the amount of breast tissue removed, any minimum age limitations, any limitation based upon maximum body weight, requirements for a trial of conservative therapy, or the exclusion of certain procedures (liposuction). 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). 1995;95(6):1029-1032. Obesity and complications in breast reduction surgery: Are restrictions justified? 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. Devalia HL, Layer GT. 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). 2015;(10):CD007258. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Rising Rates of Insurance Denial for Breast Reduction Surgery 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. 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. Three review authors undertook independent screening of the search results. 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.