ul.ur li{ Tang CL, Brown MH, Levine R, et al. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. color: red!important; The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. } text-decoration: line-through; However, these medications should be reserved for those with no decrease in breast size after 2 years. list-style-type : square !important; He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Breast and aesthetic surgery. li.bullet { The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). 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. 1999;103(6):1682-1686. 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. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. 2021;147(5):1072-1083. 1995;34(2):113-116. 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. Flancbaum L, Choban PS. Reduction mammaplasty: Defining medical necessity. Ann Plastic Surg. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? N Engl J Med. J Am Coll Surg. 2009;7(2):114-119. # color: white; 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. 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. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. 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 A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Ann Plast Surg. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). font-size: 18px; A total of 244 out of 1,628 patients with the average age of 23.13 years. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. 1993;17(3):211-223. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. } Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Aesthet Surg J. 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). Treating providers are solely responsible for medical advice and treatment of members. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. The primary outcome was the difference in wound drainage over 24 hours. 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. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Petty PM, Solomon M, Buchel EW, Tran NV. Plast Reconstr Surg. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. margin-top: 38px; 2006;118(4):840-848. For many patients the psychological impact of the disease is substantial. Evidence-based clinical practice guideline: Reduction mammaplasty. The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. 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. 2007;119(4):1159-1166. Plast Reconstr Surg. 2009;19(3):e85-e90. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Arlington Heights, IL: ASPRS; 1987. Gynecomastia: Evolving paradigm of management and comparison of techniques. padding-bottom: 4px; Khan SM, Smeulders MJ, Van der Horst CM. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. 40 . In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. 2009;62(2):195-199. Pediatr Surg Int. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. } Am J Infect Control. All RCTs that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. Patient demographics, surgical technique, and outcomes were analyzed. 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. height:2px; background-position: right 65%; 2008;61(5):493-502. 1998;101(2):361-364. 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. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. 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. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; No author listed. .newText { Management of gestational gigantomastia. 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). No data were provided on loss to follow-up. Endocrinol Metab Clin North Am. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. OL OL OL OL OL LI { Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. } Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass 2000;106(5):991-997. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). Surgical treatment of primary gynecomastia in children and adolescents. Ann Plast Surg. Med Decis Making. These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. Type II gynecomastia is more generalized breast enlargement. Arlington Heights, IL: ASPS; 2011. Level of Evidence = IV. } CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Fischer JP, Cleveland EC, Shang EK, et al. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Sood R, Mount DL, Coleman JJ 3rd, et al. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. display: block; For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Analysis was on an intention-to-treat basis. Reduction mammaplasty: An outcome study. Aesthet Surg J. Kerrigan CL, Collins ED, Kneeland TS, et al. 2008;53(3):255-261. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Prepubertal gynecomastia linked to lavender and tea tree oils. ol.numberedList LI { Obesity and complications in breast reduction surgery: Are restrictions justified? Yao Y, Yang Y, Liu J, et al. 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. J Plast Reconstr Aesthet Surg. A study by Bruhlmann and Tschopp (1998) was a retrospective study of 246 patients from a surgical practice, approximately 50 % (132) of whom returned a questionnaire about their symptoms and satisfaction with aesthetic results, and their recollection of symptoms prior to surgery. Plastic Reconstruct Surg. PLoS One. } Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Abnormal histopathological findings were more frequent in patients with reduction mammoplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). No other operation-related complications were observed. Gonzalez FG, Walton RL, Shafer B, et al. Leclere FM, Spies M, Gohritz A, Vogt PM. Plast Reconstr Surg. Plastic surgery for teenagers briefing paper. } } The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Reduction mammoplasty for macromastia. 1995;95(1):77-83. OL LI { OL OL LI { Ann Plast Surg. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Another set of breast pump supplies if you get pregnant . A cohort study of breast cancer risk in breast reduction patients. } Townsend: Sabiston Textbook of Surgery. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 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. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Br J Plast Surg. 2005;55(3):227-231. Setala L, Papp A, Joukainen S, et al. Exposure to partners using estrogen containing vaginal creams; Cancer chemotherapy (alkylating agents, methotrexate, vinca alkaloids, imatinib, combination chemotherapy), Androgen receptor blockers - bicalutamide, 5 reductase inhibitors - finasteride, dutasteride, Angiotensin converting enzyme inhibitors (captopril, enalapril), Calcium channelblockers(diltiazem, nifedipine, verapamil), Anabolic steroids(e.g., in body builders). Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. 2012;69(5):510-515. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Ann Chir Plast Esthet. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction.
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