Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. No data were provided on loss to follow-up. These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. With approval from the authors institutional ethics committee and written informed consent, a total of 22 patients with 33 abnormally hyperplastic breasts were enrolled at the First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. N Engl J Med. 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. Li CC, Fu JP, Chang SC, et al. 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:. .strikeThrough { Mistry RM, MacLennan SE, Hall-Findlay EJ. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Treating providers are solely responsible for medical advice and treatment of members. It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. 1996;20(5):391-397. list-style-type: lower-roman; 1995;61(11):1001-1005. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. All the patients recovered well and were satisfied with the cosmetic outcomes. The mean age was 42.8 years (SD 19.5 years). Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. J Pediatr Surg. Aesthetic Plast Surg. Plast Reconstr Surg. 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. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 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. 2011;128(4):243e-249e. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. position: fixed; The risks included infection, wound breakdown, scarring, and the need for re-operating. } Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). Gland Surg. 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. Wound drainage after plastic and reconstructive surgery of the breast. However, these medications should be reserved for those with no decrease in breast size after 2 years. display: none; Ann Plastic Surg. 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. Computed tomography scan of adrenal glands to identify adrenal lesions. 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. Follow-up ranged from 2 months to 3 years. Plast Reconstr Surg. Policy. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. 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. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. color: #FFF; The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. For many patients the psychological impact of the disease is substantial. } J Plast Reconstr Aesthet Surg. Townsend: Sabiston Textbook of Surgery. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. 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. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases?
1998;41(3):240-245. Glatt BS, Sarwer DB, O'Hara DE, et al. Macromastia: all . A physician-supervised diet and exercise plan may be indicated in obese patients. 40 . Reduction mammoplasty for asymptomatic members is considered cosmetic. Lonie S, Sachs R, Shen A, et al. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. 2021;147(5):1072-1083. Blomqvist L, Eriksson A, Brandberg Y. J Plast Surg Hand Surg. Petty PM, Solomon M, Buchel EW, Tran NV. 1993;91(7):1270-1276. 1995;95(6):1029-1032. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. 2005;58(3):286-289. A total of 244 out of 1,628 patients with the average age of 23.13 years. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. 2014b;30(6):641-647. 2020 Sep 4 [Online ahead of print]. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. 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. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). Thus, more than 1/3of operative subjects selected for inclusion in the study did not complete it; most of the operative subjects who did not complete the study were lost to follow-up. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. list-style-type : square !important; 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]). Howrigan P. Reduction and augmentation mammoplasty. Plast Reconstr Surg. Safran T, Abi-Rafeh J, Alabdulkarim A, et al.
Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Plast Reconstr Surg. padding: 15px; Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. This will be computed based on your body area. Obstet Gynecol Clin North Am. 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. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. 1969;44(235):291-303. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. } Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Please check your insurance policy to see whether breast reduction is a covered procedure. Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. 2007;119(4):1159-1166. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. 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. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . } 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.
Does Aetna Cover Breast Reduction? | HelpAdvisor.com color:#eee;
Breast reduction surgery - Mayo Clinic Gland Surg. Qu S, Zhang W, Li S, et al. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Mayo Clin Proc. Surgical treatment of primary gynecomastia in children and adolescents. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. J Plast Reconstr Aesthet Surg.
Does Health Insurance Cover Breast Reduction Surgery? - GoodRx The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. 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. 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. 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". # font-weight: bold; 2014a;34(3):409-416. 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. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. 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. }. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. 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. Khan SM, Smeulders MJ, Van der Horst CM. 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. Gynecomastia: A systematic review. margin-top: 38px; 2012;69(5):510-515. 1. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Current concepts in gynaecomastia. font-size: 18px; Three review authors undertook independent screening of the search results. Fischer S, Hirsch T, Hirche C, et al. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Karamanos et al (2015) identified their study as the largest sample on breast reduction in the literature, in which age and surgeon specialty did not correlate with negative results. 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. Breast J. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Burns JL, Blackwell SJ. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; 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. cursor: pointer; Handschin AE, Bietry D, Hsler R, et al. 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). Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Araco A, Gravante G, Araco F, et al. This may lead to additional scarring and additional operating time. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. height:2px; In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Reduction mammoplasty improves symptoms of macromastia. OL OL OL OL LI { 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. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. 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). If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. 2009;19(3):e85-e90. There were no restrictions on the basis of date or language of publication. The majority (87.7 %) of cases presented with accompanying mastalgia. Nguyen JT, Wheatley MJ, Schnur PL, et al. The condition not only must be unresponsive to dermatological treatments (e.g., antibiotics or antifungal therapy) and conservative measures (e.g., good skin hygiene, adequate nutrition) for a period of 6 months or longer, but also must satisfy criteria stated insection I above. Sood R, Mount DL, Coleman JJ 3rd, et al. border-width:0; Risk factors for complications following breast reduction: Results from a randomized control trial. Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). In these cases, breast reduction for men may take 2 to 3 hours. background-color: #663399; The primary outcome was the difference in wound drainage over 24 hours. First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale.
Magnetic Resonance Imaging (MRI) of the Breast - Aetna Breast Concerns of Adolescents. Special Clinical Concerns. Fischer JP, Cleveland EC, Shang EK, et al. @media print { Level of Evidence = IV.
PDF 0185 Breast Reconstructive Surgery (1) - Aetna Gonzalez FG, Walton RL, Shafer B, et al. Laituri CA, Garey CL, Ostlie DJ, et al. Oxfordshire NHS Trust. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. 1997;100(4):875-883. Other just require 500 grams no matter what your height and weight. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Breast reduction outcome study. 1999;103(6):1687-1690. 2004;113(1):436-437. Med Decis Making. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. 1998;26(1):61-65. 2015;49(6):311-318. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. Subjects were compared to age-matched norms from another study cohort. 2001;107(5):1234-1240.
Breast Reduction Surgery | Johns Hopkins Medicine Gynecomastia in patients with prostate cancer: A systematic review. Breast J.
PDF Procedures, programs and drugs you must precertify - AmeriBen Grooving where the bra straps sit on the shoulder. The Mammotome procedure represented another novel therapeutic option for gynecomastia. Breast asymmetries: A brief review and our experience. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. 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. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. J Plast Reconstr Aesthet Surg. } Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Bland KI, Copeland EM, eds. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Ann Plast Surg. Ann Plast Surg. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. padding-bottom: 4px; 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. Breast and aesthetic surgery. Plast Reconstr Surg. Flancbaum L, Choban PS. 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. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Hoyos AE, Perez ME, Dominguez-Millan R, et al. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). A total of 81 patients were included in this study. To get insurance coverage, you'll probably need . Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III).