Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Aetna considers breast reconstructive surgery to correct Setala L, Papp A, Joukainen S, et al. 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. 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 known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. Gland Surg. Oxford, UK: National Health Service (NHS); October 2008. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. 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. 2003;111(2):688-694. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. 01/04/2023 Magnetic Resonance Imaging (MRI) of the Breast - Aetna PDF Procedures, programs and drugs you must precertify - AmeriBen Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Treatment of adolescent gynecomastia. list-style-type: upper-alpha; American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. 1997;100(4):875-883. A detailed physical examination, including testicular examination. A total of 244 out of 1,628 patients with the average age of 23.13 years. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com There were only 2 studies of a total 25 patients that were considered as good in quality. # color: white; 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). Am Surg. 2005;55(3):227-231. Last Review01/04/2023. This Clinical Policy Bulletin may be updated and therefore is subject to change. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. 18th ed. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. list-style-type: upper-roman; 2007;119(4):1159-1166. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). 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). They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. 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. 2008;53(3):255-261. PLoS One. Raispis T, Zehring RD, Downey DL. The primary outcome was the difference in wound drainage over 24 hours. 1999;103(1):76-82; discussion 83-85. 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. J Plast Reconstr Aesthet Surg. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. 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). color: blue!important; Kerrigan CL, Collins ED, Kneeland TS, et al. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Macromastia: all . Level of Evidence = IV. ol.numberedList LI { 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. Breast reduction surgery - Mayo Clinic Treating providers are solely responsible for medical advice and treatment of members. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. 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. Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Washington, DC: ACOG; 2011:121-122. list-style-type: lower-alpha; Yao Y, Yang Y, Liu J, et al. Autorino R, Perdona S, D'Armiento M, et al. Plastic Reconstr Surg. 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). Grooving where the bra straps sit on the shoulder. 2001;108(1):62-67. 2019;8(4):431-440. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. 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". list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; 1993;17(3):211-223. of the following criteria must be met: 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. Administration of Benefits and Transition Responsibilities Ann Plastic Surg. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. 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. } Current concepts in gynaecomastia. 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). bottom: 20px; Gonzalez FG, Walton RL, Shafer B, et al. 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%. 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. 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). American Society of Plastic Surgeons (ASPS). Plast Reconstr Surg. }. 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. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. Surgical implications of obesity. Does Aetna Cover Breast Reduction? | HelpAdvisor.com 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). 1995;34(2):113-116. 2000;45(6):575-580. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. 1995;61(11):1001-1005. position: fixed; Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Ages ranged from 18 to 66 years. Plast Reconstr Surg. 2012;69(5):510-515. OL LI { Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. 2008;121(4):1092-1100. 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. text-decoration: underline; Little is known about the effect of surgical treatment on the psychological aspects of the disease. PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Gynecomastia in patients with prostate cancer: A systematic review. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. border-width:0; 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. 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. 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:. Can objective predictors for operative success be identified? No other operation-related complications were observed. Links to various non-Aetna sites are provided for your convenience only. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. 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. 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. .newText { These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 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. Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. padding: 15px; 2014b;48(5):334-339. 2015;10(8):e0136094. Gynecomastia: A systematic review. PDF A look at new changes coming to E&M and breast coding in 2021 These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). 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. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Breast Reduction Surgery | Johns Hopkins Medicine The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. This will be computed based on your body area. 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 . background: #5e9732; This may lead to additional scarring and additional operating time. Gynecomastia: Evolving paradigm of management and comparison of techniques. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. 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. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. 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.
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