Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Ann Plast Surg. Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . of the following criteria must be met: Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. The study subjects were stratified into groups based on ages of <60 years and 60 years. However, these medications should be reserved for those with no decrease in breast size after 2 years. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Burdette TE, Kerrigan CL, Homa KA. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Med Decis Making. Flancbaum L, Choban PS. 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. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; } Brown DM, Young VL. Plastic Reconstr Surg. /* aetna.com standards styles for templates */ Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Howrigan P. Reduction and augmentation mammoplasty. In other patients, excess skin and nipple and areola relocation are necessary. } 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. } Reduction mammaplasty: An outcome study. Mizgala CL, MacKenzie KM. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. Aetna considers breast reconstructive surgery to correct Is breast reduction covered by health insurance? | ASPS Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor Priorities Forum Policy Statement. Prepubertal gynecomastia linked to lavender and tea tree oils. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. and areola. Miller AP, Zacher JB, Berggren RB, et al. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. 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:. And if you are in Canada the surgeon decides. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. .strikeThrough { Prostate Cancer Prostatic Dis. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). 2008;61(5):493-502. All the patients recovered well and were satisfied with the cosmetic outcomes. list-style-type: upper-alpha; Operative subjects who completed the study reported reductions in pain and improvements in quality of life; however, these improvements may be attributable to placebo effects, the natural history of back pain, other concurrent interventions, regression to the mean, improvements in cosmesis (for quality of life measures), or other confounding variables that may bias in interpretation of results. 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. /*margin-bottom: 43px;*/ The nipple-areola complex was re-positioned in 60 % of patients (n = 54). From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. In a systematic review, these investigators examined the role of radiotherapy in this context. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. How to make Aetna pay for your breast reduction surgery z-index: 99; color:#eee; Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Annu Rev Med. Arlington Heights, IL: ASPS; May 2011. PDF 0185 Breast Reconstructive Surgery (1) - Aetna } } 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. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. 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. No other operation-related complications were observed. Obesity and complications in breast reduction surgery: Are restrictions justified? Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Fagerlund A, Cormio L, Palangi L, et al. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. 2014b;30(6):641-647. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. 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". Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. 2005;58(3):286-289. Copyright Aetna Inc. All rights reserved. Patient demographics, surgical technique, and outcomes were analyzed. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Another set of breast pump supplies if you get pregnant . Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. } Krieger LM, Lesavoy MA. Laituri CA, Garey CL, Ostlie DJ, et al. No necrosis, systemic infection, or muscle paralysis was reported. Rising Rates of Insurance Denial for Breast Reduction Surgery A total of 90 patients underwent breast re-reduction surgery. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Sabistons Textbook of Surgery (Burns & Blackwell, 2008)states that breast size should be stable for one year: There is no set lower age limit but, for the adolescent with breast hypertrophy, reduction is deferred until the breasts have stopped growing and are stable in size for at least 12 months before surgery.. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline 2009;62(2):195-199. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Surgeon. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Plastic surgery for teenagers briefing paper. Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). 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. 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. Level of Evidence = IV. 2014a;34(3):409-416. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Plast Reconstr Surg. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. 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 list-style-type: decimal; 1995;34(2):113-116. 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. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Plast Reconstr Surg. They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Autorino R, Perdona S, D'Armiento M, et al. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. Breast reduction surgery - Mayo Clinic 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].
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