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Plast Reconstr Surg. A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. Wound drainage after plastic and reconstructive surgery of the breast. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. To get insurance coverage, you'll probably need . Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. 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. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 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). Reduction mammaplasty. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Leclere FM, Spies M, Gohritz A, Vogt PM. 2006;118(4):840-848. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. 2007;119(4):1159-1166. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. } Plast Reconstr Surg. Plastic Reconstruct Surg. Disproportionately large breasts can cause both physical and emotional . Philadelphia, PA: W.B. OL LI { Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Does Aetna Cover Breast Reduction? | HelpAdvisor.com The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Gland Surg. In these cases, breast reduction for men may take 2 to 3 hours. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. 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). 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). Oxford, UK: National Health Service (NHS); October 2008. Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com 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. 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. Breast J. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 2018;7(Suppl 1):S70-S76. hr.separator { Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. Policy Statement 6d: Aesthetic surgery procedures. Gynecomastia: A systematic review. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. 2000;106(5):991-997. Mental health care professionals may be consulted to address psychological distress from gynecomastia. There were only 2 studies of a total 25 patients that were considered as good in quality. } 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. Evidence-based clinical practice guideline: Reduction mammaplasty. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; .newText { 40 . The health burden of breast hypertrophy. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. } Breast reduction for symptomatic macromastia. list-style-type: decimal; 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. Horm Res Paediatr. 2014a;34(3):409-416. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. border-radius: 4px; Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Study subjects included 3538 patients with an average age of 43 years and body mass index of 31.6 kg/m(2) and most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes.The incidence of overall surgical complications was 5.1% and the incidence of major surgical complications was 2.1%. outline: none; 2016;20(3):256-260. 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. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Arlington Heights, IL: ASPS; 2011. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Plast Reconstr Surg. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. (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. Schnur PL, Hoehn JG, Ilstrup DM, et al. 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: Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. Arlington Heights, IL: ASPRS; 1987. 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.. z-index: 99; Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Obstet Gynecol Clin North Am. Breast Reduction | American Society of Plastic Surgeons These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 1990;24(1):61-67. No necrosis, systemic infection, or muscle paralysis was reported. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Plastic surgery for teenagers briefing paper. 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). A follow-up study of 105 women with breast cancer following reduction mammaplasty. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). The primary outcome was the difference in wound drainage over 24 hours. 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. Reduction mammoplasty improves symptoms of macromastia. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. GP Notebook. The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. 2014b;48(5):334-339. Many men with breast enlargement are found to have pseudo-gynecomastia. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Plast Reconstr Surg. Devalia HL, Layer GT. Surgical treatment of primary gynecomastia in children and adolescents. ASPS clinical practice guideline summary on reduction mammaplasty. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Aesthetic Plast Surg. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Aesthet Surg J. 2019;166(5):934-939. cursor: pointer; 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:. Macromastia: all . color: red 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. 1993;91(7):1270-1276. 2013;71(5):471-475. Gonzalez FG, Walton RL, Shafer B, et al. 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. Grooving where the bra straps sit on the shoulder. 2021 Aug 11 [Online ahead of print]. When seeking preauthorization for a breast reduction, your goal is generally twofold. Gynecomastia: Evolving paradigm of management and comparison of techniques. Please check your insurance policy to see whether breast reduction is a covered procedure. A total of 244 out of 1,628 patients with the average age of 23.13 years. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Reduction mammaplasty: An outcome study. 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. } Kerrigan CL, Collins ED, Kneeland TS, et al. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. 2 . The nipple-areola complex was re-positioned in 60 % of patients (n = 54). 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. Autorino R, Perdona S, D'Armiento M, et al. 2001;108(6):1591-1599. li.bullet { Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . 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. Major complications (1.6 %) included unilateral hematoma and localized infection. of . However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. 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). A total of 90 patients underwent breast re-reduction surgery. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. /* aetna.com standards styles for templates */ 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 2007;356(5):479-485. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor Prepubertal gynecomastia linked to lavender and tea tree oils. A population-level analysis of bilateral breast reduction: does age affect early complications? Links to various non-Aetna sites are provided for your convenience only. A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio). The risks included infection, wound breakdown, scarring, and the need for re-operating. J Am Coll Surg. bottom: 20px; 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. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. Prostate Cancer Prostatic Dis. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. 2021;74(11):3128-3140. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . }. margin-bottom: 38px; Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Recommended criteria for insurance coverage of reduction mammoplasty. Little is known about the effect of surgical treatment on the psychological aspects of the disease. 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. Washington, DC: ACOG; 2011:121-122. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna American Society of Plastic Surgeons (ASPS). Ann Plast Surg. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass 2012;130(4):785-789. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. The authors concluded that the limited evidence available showed no significant benefit of using post-operative wound drains in reduction mammoplasty, although LOS may be shorter when drains are not used. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Plastic Reconstr Surg. Other just require 500 grams no matter what your height and weight. Surgical treatment is indicated when medical treatments fail. 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]). Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. All the patients recovered well and were satisfied with the cosmetic outcomes. 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 . Breast cancer found at the time of breast reduction. Sugrue CM, McInerney N, Joyce CW, et al. 1993;17(3):211-223. PDF A look at new changes coming to E&M and breast coding in 2021 Reduction mammaplasty provides long-term improvement in health status and quality of life. Ages ranged from 18 to 66 years. Blomqvist L, Eriksson A, Brandberg Y. Annu Rev Med. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna In: Townsend CM, Beuchamp RD, Evers BM, eds. 2005;58(3):286-289. Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. Gynaecomastia. The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. Ann Plast Surg. He Q, Zheng L, Zhuang D, et al. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. padding-bottom: 4px; Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. 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. Seitchik MW. A non-standardized survey showed a very high satisfaction index. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Operative subjects who completed the study reported reductions in pain and improvements in quality of life; however, these improvements may be attributable to placebo effects, the natural history of back pain, other concurrent interventions, regression to the mean, improvements in cosmesis (for quality of life measures), or other confounding variables that may bias in interpretation of results. In the case of breast reduction, however, for insurance purposes, it . Flancbaum L, Choban PS. Yao Y, Yang Y, Liu J, et al. Saunders Co.; 1991. 1999;103(6):1674-1681. Arlington Heights, IL: ASPS; May 2011. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Khan SM, Smeulders MJ, Van der Horst CM. In a systematic review, these investigators examined the role of radiotherapy in this context. 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". 1995;95(1):77-83. 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. Hello! Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Breast Concerns of Adolescents. 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). Swelstad MR, Swelstad BB, Rao VK, Gutowski KA.