Washington, DC: ACOG; 2011:121-122. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Priorities Forum Policy Statement. z-index: 99; of the following criteria must be met: Mental health care professionals may be consulted to address psychological distress from gynecomastia. 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). Aesthetic Plast Surg. Ann Plast Surg. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Plast Reconstr Surg. ASPS Recommended Coverage Criteria for Third Party Payors. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Links to various non-Aetna sites are provided for your convenience only. Second, it is the burden of the proponent of an intervention to provide reliable evidence of its effectiveness, not the burden of ones whoquestion the effectivenessan intervention to provide definitive proof of ineffectiveness. Asian J Surg. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. J Plast Surg Hand Surg. 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. 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". Plast Reconstr Surg. Management of gestational gigantomastia. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. 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. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Please check your insurance policy to see whether breast reduction is a covered procedure. 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. These preliminary findings need to be validated by well-designed studies. 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. 2014a;34(1):66-73. Variations in pattern of pubertal changes in girls. A systematic search of the published literature was performed. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. .strikeThrough { margin-bottom: 38px; 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. } Risk of bias was assessed independently by 2review authors. How to make Aetna pay for your breast reduction surgery Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. 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). Khan SM, Smeulders MJ, Van der Horst CM. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . 2000;106(5):991-997. 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. Breast Reduction Surgery | Johns Hopkins Medicine 2006;9(2):109-114. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Sugrue CM, McInerney N, Joyce CW, et al. Long-term functional results after reduction mammoplasty. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. 2006;30(3):309-319. 2007;356(5):479-485. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna 18th ed. Reduction mammaplasty: Defining medical necessity. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. 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. 2001;76(5):503-510. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. 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). Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Ann Plast Surg. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). border-width:0; Breast hypertrophy. For many patients the psychological impact of the disease is substantial. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Arlington Heights, IL: ASPRS; 1987. There were 18 out of 415 studies eligible to review. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . } Arlington Heights, IL: ASPS; May 2011. Copyright Aetna Inc. All rights reserved. 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. Special Clinical Concerns. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. 2018;7(Suppl 1):S70-S76. 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. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. OL OL OL LI { Plast Reconstr Surg. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. } These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Breast asymmetries: A brief review and our experience. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. 2015;(10):CD007258. 2007;119(4):1159-1166. 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). background-color: #663399; Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. cursor: pointer; My Experience of Having Breast Reduction Surgery - Health Annu Rev Med. 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. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Prepubertal gynecomastia linked to lavender and tea tree oils. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Treatment of adolescent gynecomastia. Miller AP, Zacher JB, Berggren RB, et al. Emiroglu M, Salimoglu S, Karaali C, et al. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). 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. Gynecomastia may be drug-induced. Howrigan P. Reduction and augmentation mammoplasty. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. 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. Li CC, Fu JP, Chang SC, et al. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. All patients underwent routine investigations to exclude secondary causes of gynecomastia. Three review authors undertook independent screening of the search results. } Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. What are Aetna breast reduction requirements? - RealSelf.com Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. skin should not be excised horizontally below the inframammary fold. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. border: none; 1996;20(5):391-397. When seeking preauthorization for a breast reduction, your goal is generally twofold. 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. 2019;166(5):934-939. OL LI { The mean age was 42.8 years (SD 19.5 years). 1995;34(2):113-116. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. right: 30px; .newText { Reduction mammoplasty for macromastia. 2000;106(2):280-288. Philadelphia, PA: W.B. 1998;26(1):61-65. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). Raispis T, Zehring RD, Downey DL. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary.
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