Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for 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. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Breast reduction for symptomatic macromastia. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Reduction mammoplasty: Cosmetic or reconstructive procedure? The Mammotome procedure represented another novel therapeutic option for gynecomastia. list-style-type: upper-roman; My Experience of Having Breast Reduction Surgery - Health Blomqvist L, Eriksson A, Brandberg Y. 2003;111(2):688-694. 2006;9(2):109-114. For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. American Society of Plastic and Reconstructive Surgery (ASPRS). 2006;30(3):309-319. Gland Surg. 1999;103(6):1674-1681. In the case of breast reduction, however, for insurance purposes, it . 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. The studies used to support the arguments for the medical necessity of breast reduction surgery are poorly controlled and therefore subject to a substantial risk of bias in the interpretation of results. No new trials were identified for this first update. 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. Evidence-based clinical practice guideline: Reduction mammaplasty. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Fischer JP, Cleveland EC, Shang EK, et al. ol.numberedList LI { list-style-type: decimal; Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. 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]). In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Magnetic Resonance Imaging (MRI) of the Breast - Aetna For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). GP Notebook. 1998;41(3):240-245. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. } Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Follow-up ranged from 2 months to 3 years. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. 2009;19(3):e85-e90. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. cursor: pointer; Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Mizgala CL, MacKenzie KM. 1996;20(5):391-397. Plast Reconstr Surg. Philadelphia, PA: W.B. Oxford, UK: National Health Service (NHS); October 2008. Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. Setala L, Papp A, Joukainen S, et al. PLoS One. In: Townsend CM, Beuchamp RD, Evers BM, eds. Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. Glatt BS, Sarwer DB, O'Hara DE, et al. The average age was 24.7 years (range of 18 to 47 years). background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; } #backTop:hover { } 2008;61(5):493-502. 2018;89(6):408-412. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. 2005;55(3):227-231. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass 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. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Annu Rev Med. 2017;139(6):1313-1322. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. 2010;45(3):650-654. Coding In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). 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. Level of Evidence = III. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Socioeconomic Committee Position Paper. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. 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. 2015;49(6):311-318. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. The health burden of breast hypertrophy. Li CC, Fu JP, Chang SC, et al. He Q, Zheng L, Zhuang D, et al. Flancbaum L, Choban PS. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. 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. Current concepts in gynaecomastia. /*margin-bottom: 43px;*/ Collis N, McGuiness CM, Batchelor AG. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Plastic Reconstr Surg. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 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. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. All the patients recovered well and were satisfied with the cosmetic outcomes. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. Plastic surgery for teenagers briefing paper. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). Breast cancer found at the time of breast reduction. 2002;33:208-217. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Plast Reconstr Surg. J Plast Surg Hand Surg. 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. Please check your insurance policy to see whether breast reduction is a covered procedure. color:#eee; The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). z-index: 99; Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. 2019;8(4):431-440. background-color: #663399; Breast reduction surgery - Mayo Clinic Long-term functional results after reduction mammoplasty. color: blue!important; Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Although the BRAVO study nominally included a "control group", there was no comparison group of subjects selected from the same cohort, who were randomized or otherwise appropriately assigned to reduce bias, and treated with conservative management according to a protocol to ensure optimal conservative care. Kerrigan CL, Collins ED, Striplin D, et al. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. 2014a;34(3):409-416. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. Washington, DC: ACOG; 2011:121-122. Aesthet Surg J. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Handschin AE, Bietry D, Hsler R, et al. Ann Chir Plast Esthet. Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). What can I do if my insurance denies coverage for breast reduction? The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Gynaecomastia. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. The primary outcome was the difference in wound drainage over 24 hours. 2 . 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. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Plast Reconstr Surg. Plast Reconstr Surg. Kerrigan CL, Collins ED, Kneeland TS, et al. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. 40 . A non-standardized survey showed a very high satisfaction index. Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. 1994;21(3):539-543. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. J Plast Reconstr Aesthet Surg. Seitchik MW. Because reduction mammoplasty may be used for both medically necessary and cosmetic indications, Aetna has set forth above objective criteria to distinguish medically necessary reduction mammoplasty from cosmetic reduction mammoplasty.