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. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. 1998;49:215-234. Does Aetna Cover Breast Reduction? | HelpAdvisor.com 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. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. 2019;8(4):431-440. A total of 244 out of 1,628 patients with the average age of 23.13 years. Obstet Gynecol Clin North Am. background-position: right 65%; However, these medications should be reserved for those with no decrease in breast size after 2 years. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. Breast J. Collins ED, Kerrigan CL, Kim M, et al. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor (25 y/o female with a 38J bra size) according to aetna, I should more than qualify for a reduction as I have back, neck, shoulder pain, chest pain and pressure, arm numbness while laying on sides, etc. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Brown DM, Young VL. 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. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. 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. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Mistry RM, MacLennan SE, Hall-Findlay EJ. 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. 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. PDF Gender Dysphoria Treatment - Cigna .fixedHeaderWrap { Secondary outcomes included subjective as well as objective assessments of pain and wound healing. J Plast Surg Hand Surg. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. For many patients the psychological impact of the disease is substantial. Breast reduction surgery - Mayo Clinic Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. In a systematic review, these investigators examined the role of radiotherapy in this context. Plast Reconstr Surg. The majority (87.7 %) of cases presented with accompanying mastalgia. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. The mean age was 42.8 years (SD 19.5 years). 2007;119(4):1159-1166. Surgical implications of obesity. 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. 1999;103(6):1682-1686. J Laparoendosc Adv Surg Tech A. 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. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Wound drainage after plastic and reconstructive surgery of the breast. The authors stated that operative subjects were told that their responses to the questionnaire were not to be used for insurance and thus the subjects had no motivation to exaggerate symptoms prior to surgery in questionnaire responses; however, it is not clear whether operative subjects would be willing to submit responses to a questionnaire from the doctor that differed substantially from the history that they provided to the doctor during their preoperative evaluation. Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. Surgeon. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. 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. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Three review authors undertook independent screening of the search results. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 1991;27(3):232-237. Reduction mammaplasty. Ann Chir Plast Esthet. Plast Reconstr Surg. 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. Prepubertal gynecomastia linked to lavender and tea tree oils. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. 2020 Sep 4 [Online ahead of print]. The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Variations in pattern of pubertal changes in girls. 2018;7(Suppl 1):S70-S76. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Plast Reconstr Surg. The Breast: Comprehensive Management of Benign and Malignant Diseases. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; OL OL LI { padding: 10px; } A total of 90 patients underwent breast re-reduction surgery. No other operation-related complications were observed. Aesthetic Plast Surg. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Plastic Reconstr Surg. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. 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. This may lead to additional scarring and additional operating time. Breast J. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. #backTop:hover { Endocrinol Metab Clin North Am. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. What are Aetna breast reduction requirements? - RealSelf.com Grooving where the bra straps sit on the shoulder. Plast Reconstr Surg. Marshall WA, Tanner JM. 1998;26(1):61-65. 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. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. 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 effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Plastic Reconstruct Surg. } 18th ed. Li CC, Fu JP, Chang SC, et al. Breast hypertrophy. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. Lonie S, Sachs R, Shen A, et al. 2015;49(6):363-366. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. This Clinical Policy Bulletin may be updated and therefore is subject to change. 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. A cohort study of breast cancer risk in breast reduction patients. To get insurance coverage, you'll probably need . Annu Rev Med. 2015;(10):CD007258. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 2007;356(5):479-485. Type II gynecomastia is more generalized breast enlargement. hr.separator { Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . color: red!important; 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. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or Breast pumps. A population-level analysis of bilateral breast reduction: does age affect early complications? 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. 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. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. padding-bottom: 4px; Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). J Plast Surg Hand Surg. Kerrigan CL, Collins ED, Striplin D, et al. Abnormalities in Adolescent Breast Development. Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). The following procedures are considered experimental and investigational because there is insufficient evidence of itseffectiveness or itseffectiveness has not been established: Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. 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). Aesthet Surg J. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). text-decoration: underline; Management of gestational gigantomastia. 1997;185(6):593-603. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. and areola. 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. 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. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. } Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review The characteristics of patients as well as the curative effects between the 2 groups were analyzed. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). list-style-type: decimal; 01/04/2023 # color: white; 40 . 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). However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Note: Chronic intertrigo, eczema, dermatitis, and/or ulceration in the infra-mammary fold in and of themselves are not considered medically necessary indications for reduction mammoplasty. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. 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). He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. 1998;41(3):240-245. Ann Plastic Surg. 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 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. Surgical treatment of primary gynecomastia in children and adolescents. 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. 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. 2005;55(3):227-231. Plast Reconstr Surg. Burns JL, Blackwell SJ. Flancbaum L, Choban PS. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. J Plast Surg Hand Surg. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. N Engl J Med. Subjects were compared to age-matched norms from another study cohort. 2018;24(6):1043-1045. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. Aesthetic Plast Surg. Burdette TE, Kerrigan CL, Homa KA. Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). 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). Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Devalia HL, Layer GT. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. 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.
Giants Despair Hillclimb 2021 Results, Millcreek Townhomes Tonawanda, Ny, Articles A