aetna breast reduction requirements

Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Ann Chir Plast Esthet. 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:. J Plast Surg Hand Surg. 2nd ed. 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. 2007;119(4):1159-1166. Tang CL, Brown MH, Levine R, et al. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. A total of 81 patients were included in this study. Surgeon. padding: 15px; They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. 2016;20(3):256-260. border: none; Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Links to various non-Aetna sites are provided for your convenience only. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? An 18-question survey was created evaluating various aspects of BBR practice; UK and Irish plastic and reconstructive and breast surgeons were invited to participate by an e-mail containing a link to a web-based survey. Philadelphia, PA: W.B. A total of 244 out of 1,628 patients with the average age of 23.13 years. A non-standardized survey showed a very high satisfaction index. position: fixed; This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Aesthetic Plast Surg. Araco A, Gravante G, Araco F, et al. Am Surg. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Other just require 500 grams no matter what your height and weight. Reduction mammaplasty: Defining medical necessity. Gynecomastia in patients with prostate cancer: Update on treatment options. Plast Reconstr Surg. color: #FFF; GP Notebook. Collis N, McGuiness CM, Batchelor AG. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. 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. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Howrigan P. Reduction and augmentation mammoplasty. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. 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. list-style-type: decimal; Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Gonzalez FG, Walton RL, Shafer B, et al. 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. Miller AP, Zacher JB, Berggren RB, et al. Surgical treatment is indicated when medical treatments fail. 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. In the case of reduction mammoplasty for relief of back, neck and shoulder pain, Aetna has considered this procedure medically necessary in women with excessively large breasts because it seems logical, even in the absence of firm clinical trial evidence, that this excessive weight would contribute to back and shoulder pain, and that removal of this excessive breast tissue would provide substantial pain relief, reductions in disability, and improvements in function. /* aetna.com standards styles for templates */ Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). 2001;107(5):1234-1240. 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%. As explained below, 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. Ann Plast Surg. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. How to make Aetna pay for your breast reduction surgery American Society of Plastic and Reconstructive Surgery (ASPRS). Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. 2003;111(2):688-694. Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years). Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Qu S, Zhang W, Li S, et al. Reduction mammoplasty: Cosmetic or reconstructive procedure? Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. list-style-type: decimal; 18th ed. No necrosis, systemic infection, or muscle paralysis was reported. 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. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Surgery. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Hoyos AE, Perez ME, Dominguez-Millan R, et al. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. N Engl J Med. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Gynecomastia may be drug-induced. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Breast Concerns of Adolescents. 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). Ages ranged from 18 to 66 years. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. 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). Laituri CA, Garey CL, Ostlie DJ, et al. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note Burdette TE, Kerrigan CL, Homa KA. Abnormalities in Adolescent Breast Development. Mayo Clin Proc. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. 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. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. } Breast pumps. Often times, insurance company will dictate how much breast tissue to be removed. Am J Infect Control. 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. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Breast Reduction Surgery | Johns Hopkins Medicine width: 100%; Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Follow-up ranged from 2 months to 3 years. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Refer to the member's specific plan document for applicable coverage. 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., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. 1997;185(6):593-603. Plast Reconstr Surg. } This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. Autorino R, Perdona S, D'Armiento M, et al. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Kerrigan CL, Collins ED, Kim HM, et al. 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 median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. This will be computed based on your body area. Breast J. 2000;106(5):991-997. J Am Coll Surg. color: red The majority (87.7 %) of cases presented with accompanying mastalgia. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 2013;71(5):471-475. Kerrigan CL, Collins ED, Striplin D, et al. Please check your insurance policy to see whether breast reduction is a covered procedure. 2009;19(3):e85-e90. 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. 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. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Plast Reconstr Surg. Surgical treatment of primary gynecomastia in children and adolescents. and areola. A physician-supervised diet and exercise plan may be indicated in obese patients. Treatment of adolescent gynecomastia. 2011;128(4):243e-249e. skin should not be excised horizontally below the inframammary fold. 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). Gland Surg. #closethis { Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. He Q, Zheng L, Zhuang D, et al. } 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. Fischer S, Hirsch T, Hirche C, et al. } Devalia HL, Layer GT. 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. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammoplasty regarding physical symptoms and body image. Brown MH, Weinberg M, Chong N, et al. ul.ur li{ background-color: #663399; A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. PDF 0185 Breast Reconstructive Surgery (1) - Aetna The health burden of breast hypertrophy. 1998;101(2):361-364. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the 1995;95(1):77-83. 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. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. J Plast Reconstr Aesthet Surg. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Breast reduction surgery - Mayo Clinic Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline Plast Reconstr Surg. Aesthetic Plast Surg. Plast Reconstr Surg. Plastic Reconstruct Surg. Plast Reconstr Surg. Tang CL, Brown MH, Levine R, et al. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Policy. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Plast Reconstr Surg. Determinants of surgical site infection after breast surgery. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life 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. These preliminary findings need to be validated by well-designed studies. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. 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. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Chadbourne EB, Zhang S, Gordon MJ, et al. 1998;26(1):61-65. Raispis T, Zehring RD, Downey DL. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. 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. 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. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. Hello! 2015;(10):CD007258. 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. Fagerlund A, Cormio L, Palangi L, et al. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Computed tomography scan of adrenal glands to identify adrenal lesions. 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. Ann Plast Surg. Breast. Socioeconomic Committee Position Paper. PDF Procedures, programs and drugs you must precertify - AmeriBen The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. 2021 Aug 11 [Online ahead of print]. No new trials were identified for this first update. Arlington Heights, IL: ASPS; May 2011. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Reduction mammoplasty for macromastia. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Plastic surgery for teenagers briefing paper. 2000;45(6):575-580. The mean volume of tissue resected was 250 g (range of 22 to 758 g) from the right breast and 244 g (range of 15 to 705 g) from the left breast. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Oxfordshire NHS Trust. 1990;24(1):61-67. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. 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. 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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