Plastic Reconstruct Surg. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. border: none; These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Brown DM, Young VL. Breast reduction outcome study. Gonzalez FG, Walton RL, Shafer B, et al. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. No other operation-related complications were observed. The Mammotome procedure represented another novel therapeutic option for gynecomastia. 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. 2012;130(4):785-789. 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: 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). 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). 1999;103(6):1687-1690. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . 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. } 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. In a review on Surgical treatment of primary gynecomastia in children and adolescents, Fischer et al (2014b) concluded that surgical correction of gynecomastia remains a purely elective intervention. Breast Concerns of Adolescents. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. 2011;128(4):243e-249e. Cochrane Database Syst Rev. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. 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). Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Type II gynecomastia is more generalized breast enlargement. 1969;44(235):291-303. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne PLoS One. Brown MH, Weinberg M, Chong N, et al. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Aesthetic Plast Surg. PDF Summary of Proposed Aetna Medicare Advantage Agreement 2008;53(3):255-261. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). 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. Burdette TE, Kerrigan CL, Homa KA. 1. 2016;20(3):256-260. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Endocrinol Metab Clin North Am. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Reduction mammoplasty for macromastia. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. 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. .newText { Philadelphia, PA: W.B. Level of Evidence = IV. 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. There were only 2 studies of a total 25 patients that were considered as good in quality. A total of 81 patients were included in this study. 2001;108(1):62-67. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Plast Reconstr Surg. 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. Plast Reconstr Surg. of . The authors reach the remarkable conclusion that a woman with normal sized breasts who has only a few ounces of breast tissue removed is as likely to receive as much benefit from breast reduction surgery as a women with large breasts who has substantially more breast tissue removed. Miller AP, Zacher JB, Berggren RB, et al. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. How to make Aetna pay for your breast reduction surgery Breast Reduction | American Society of Plastic Surgeons All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna Plast Reconstr Surg. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. Level of Evidence = IV. 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. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note Surgery. 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). 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. Howrigan P. Reduction and augmentation mammoplasty. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Ann Chir Plast Esthet. The authorsleave the reader with the conclusionthat decisions about the medical necessity of breast reduction surgery in symptomatic women should be left entirely to the surgeon's discretion. What can I do if my insurance denies coverage for breast reduction? margin-top: 38px; 2015;10(8):e0136094. A non-standardized survey showed a very high satisfaction index. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Arlington Heights, IL: ASPS; March 9, 2002. 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. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. position: fixed; It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. CG-SURG-71 Reduction Mammaplasty - Anthem 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. 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). Long-term functional results after reduction mammoplasty. American Society of Plastic Surgeons (ASPS). Breast J. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Aesthetic Plast Surg. 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 . PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com 2002;109(5):1556-1566. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. }. top: 0px; For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. 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 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. Socioeconomic Committee Position Paper. No author listed. Aetna considers breast reconstructive surgery to correct No data were provided on loss to follow-up. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Level of Evidence = IV. A population-level analysis of bilateral breast reduction: does age affect early complications? Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. 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). Magnetic Resonance Imaging (MRI) of the Breast - Aetna 2013;71(5):471-475. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Plast Reconstr Surg. 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. Gynecomastia in patients with prostate cancer: A systematic review. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. 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). 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. Setala L, Papp A, Joukainen S, et al. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Ann Plast Surg. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. 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. Ann Plast Surg. Am Surg. J Plast Reconstr Aesthet Surg. Mayo Clin Proc. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. 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. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. } Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Bertin ML, Crowe J, Gordon SM. # font-weight: bold; Lonie S, Sachs R, Shen A, et al. Med Decis Making. 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. Devalia HL, Layer GT. } (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) 1990;24(1):61-67. Risk of bias was assessed independently by 2review authors. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). 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. } Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. 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. PDF A look at new changes coming to E&M and breast coding in 2021 From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. The health burden of breast hypertrophy. The majority (87.7 %) of cases presented with accompanying mastalgia. However, it is unclear if there is any evidence to support this practice. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Arlington Heights, IL: ASPRS; 1987. Ann Plast Surg. Also, there was no correlation between PR expression and 2D: 4D. In these cases, breast reduction for men may take 2 to 3 hours. An 18-question survey was created evaluating various aspects of BBR practice; UK and Irish plastic and reconstructive and breast surgeons were invited to participate by an e-mail containing a link to a web-based survey. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). text-decoration: underline; Aesthet Plastic Surg. 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. There were 18 out of 415 studies eligible to review. 1998;49:215-234. 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. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor Gynecomastia has been classified into2 types. 2014;20(3):274-278. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. Reduction mammoplasty: Cosmetic or reconstructive procedure? OL LI { Hoyos AE, Perez ME, Dominguez-Millan R, et al. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. 2 . list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; 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. Tang CL, Brown MH, Levine R, et al. Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com Reduction mammaplasty: An outcome study. N Engl J Med. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). 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. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Breast Reduction Surgery | Johns Hopkins Medicine Am J Infect Control. Gynecomastia: Evolving paradigm of management and comparison of techniques. 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. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Br J Plast Surg. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. 2015;(10):CD007258. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. 1991;27(3):232-237. Major complications (1.6 %) included unilateral hematoma and localized infection. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 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. 01/04/2023 Laituri CA, Garey CL, Ostlie DJ, et al. 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. display: block; Fischer JP, Cleveland EC, Shang EK, et al. } Plast Reconstr Surg. 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. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. American Society of Plastic Surgeons (ASPS). This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates.

Jacksonville Daily Progress Cherokee County Arrests, Articles A