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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). Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? A physician-supervised diet and exercise plan may be indicated in obese patients. 2 . breast augmentation with implant. 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). Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 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. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. 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. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Fischer S, Hirsch T, Hirche C, et al. OL OL OL LI { Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. of . The health burden of breast hypertrophy. J Plast Reconstr Aesthet Surg. How to make Aetna pay for your breast reduction surgery } 2004;113(1):436-437. The mean age was 42.8 years (SD 19.5 years). This will be computed based on your body area. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . 2001;108(1):62-67. background-color:#eee; In this study the National Surgical Quality Improvement Program data set was queried for the Current Procedural Terminology code 19318 from the years 2005 to 2010, with principal outcome measurements of wound complications, surgical site infections, and reoperations. Plastic surgery for teenagers briefing paper. Sood R, Mount DL, Coleman JJ 3rd, et al. Surgery. } Reduction mammaplasty: Defining medical necessity. A cohort study of breast cancer risk in breast reduction patients. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Gland Surg. 2018;24(6):1043-1045. text-decoration: underline; Resolution of idiopathic gynecomastia may take several months to years. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Level of Evidence = IV. Li CC, Fu JP, Chang SC, et al. 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. 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: 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. Marshall WA, Tanner JM. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. 2014a;34(3):409-416. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. 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. Special Clinical Concerns. In a systematic review, these investigators examined the role of radiotherapy in this context. Priorities Forum Policy Statement. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. of the following criteria must be met: Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna 2010;125(5):1301-1308. 2014;20(3):274-278. 2003;111(2):688-694. No author listed. For individuals who received radiation treatment to the chest . The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Aesthetic Plast Surg. Macromastia: all . bottom: 20px; } Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. PDF Gender Dysphoria Treatment - Cigna } Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Kerrigan CL, Collins ED, Kim HM, et al. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. 2015;(10):CD007258. Quality of life after breast reduction. list-style-type : square !important; Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Ann Plast Surg. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). right: 30px; Petty PM, Solomon M, Buchel EW, Tran NV. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. 2017;35:157-161. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. 1999;103(6):1674-1681. The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. Breast reduction outcome study. color:#eee; Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). 2014b;48(5):334-339. All the patients recovered well and were satisfied with the cosmetic outcomes. color: red Krieger LM, Lesavoy MA. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. 2009;7(2):114-119. ul.ur li{ A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. American Society of Plastic Surgeons (ASPS). Policy Statement 6d: Aesthetic surgery procedures. 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. The authors concluded that breast re-reduction can be performed safely and predictably, even when the previous technique is not known; and 4 key principles were developed: Language services can be provided by calling the number on your member ID card. Surgical implications of obesity. Breast Reduction Surgery | Johns Hopkins Medicine .newText { 2021;147(5):1072-1083. Plastic Reconstr Surg. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. In: Townsend CM, Beuchamp RD, Evers BM, eds. Narula HS, Carlson HE. hr.separator { Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. # font-weight: bold; Wound drainage after plastic and reconstructive surgery of the breast. Treating providers are solely responsible for medical advice and treatment of members. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. Plast Reconstr Surg. Socioeconomic Committee Position Paper. 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. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. 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). Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. position: fixed; Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Arlington Heights, IL: ASPS; 2011. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. 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. 2007;119(4):1159-1166. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. .headerBar { Analysis was on an intention-to-treat basis. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. 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. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. background-position: right 65%; 2001;76(5):503-510. Administration of Benefits and Transition Responsibilities Management of gestational gigantomastia. Khan SM, Smeulders MJ, Van der Horst CM. 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. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . Subjects were compared to age-matched norms from another study cohort. American Society of Plastic Surgeons (ASPS). } #backTop:hover { J Pediatr Surg. Ann Plastic Surg. 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. 1. 1995;61(11):1001-1005. 2009;62(2):195-199. 2008;32(1):38-44. cursor: pointer; The end-point was the complete resolution of gynecomastia. Level of Evidence = IV. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. Annu Rev Med. 1969;44(235):291-303. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). padding: 10px; 40 . list-style-type: lower-roman; All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). } PDF Summary of Proposed Aetna Medicare Advantage Agreement The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Aesthet Surg J. 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. } Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. 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. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. 2020 Sep 4 [Online ahead of print]. 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 . Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. list-style-type: lower-alpha; Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Surgeon. 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. Nguyen JT, Wheatley MJ, Schnur PL, et al. 2013;71(5):471-475. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. padding: 15px; The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. Washington, DC: ACOG; 2011:121-122. Surgical treatment of gynecomastia: Complications and outcomes. Plastic Reconstruct Surg. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Links to various non-Aetna sites are provided for your convenience only. Breast pumps. margin-bottom: 38px; PLoS One. Principles of breast re-reduction: A reappraisal. Is breast reduction covered by health insurance? | ASPS 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. No statistically significant differences in the drainage, level of pain, size of open areas, clinical appearance, degree of scar pliability, or scar erythema were noted. 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. Surgical treatment is indicated when medical treatments fail. 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. 2005;55(3):227-231. My Experience of Having Breast Reduction Surgery - Health Araco A, Gravante G, Araco F, et al. Am Surg. Br J Plast Surg. 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. 18th ed. #closethis { Women's Health and Cancer Rights Act of 1998. Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. GP Notebook. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. 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. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. 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. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. .strikeThrough { 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). Plast Reconstr Surg. Philadelphia, PA: W.B. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Reduction mammaplasty: The need for prospective randomized studies. The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). Plast Reconstr Surg. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. 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). Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. 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. American Society of Plastic Surgeons (ASPS). Ann Plast Surg. OL LI { Breast reduction for symptomatic macromastia. 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. 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). Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. 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. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Ann Plast Surg. } Blomqvist L, Eriksson A, Brandberg Y. Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? 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]). The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. 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.

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