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The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Statistical analysis was performed with student t-test and chi-square test. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. 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. Follow-up ranged from 2 months to 3 years. 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). American Society of Plastic and Reconstructive Surgery (ASPRS). Variations in pattern of pubertal changes in girls. 2015;49(6):363-366. Level of Evidence = III. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? A follow-up study of 105 women with breast cancer following reduction mammaplasty. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Bertin ML, Crowe J, Gordon SM. Ann Plast Surg. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. 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., breast size stable over one year) when any of the following criteria (A, B, or C) is met: Macromastia: all of the following criteria must be met: The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. A total of 15 articles met the inclusion criteria for review. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. 18th ed. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Saunders Co.; 1991. J Plast Reconstr Aesthet Surg. For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. 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. The health burden of breast hypertrophy. 1996;20(5):391-397. Patient demographics, surgical technique, and outcomes were analyzed. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Resolution of idiopathic gynecomastia may take several months to years. 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 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. Hello! } Collins ED, Kerrigan CL, Kim M, et al. 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. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor 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. 2000;45(6):575-580. Petty PM, Solomon M, Buchel EW, Tran NV. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Plast Reconstr Surg. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. 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. PDF Gender Dysphoria Treatment - Cigna Surgical treatment of gynecomastia: Complications and outcomes. Sugrue CM, McInerney N, Joyce CW, et al. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Burdette TE, Kerrigan CL, Homa KA. color: blue Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Level of Evidence = IV. color: red!important; Seitchik MW. J Plast Reconstr Aesthet Surg. Reduction mammoplasty for asymptomatic members is considered cosmetic. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Gynecomastia is a very common concern of male adolescence. Brown DM, Young VL. Little is known about the effect of surgical treatment on the psychological aspects of the disease. cursor: pointer; Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. right: 30px; Current concepts in gynaecomastia. padding-right: 18px; 1999;103(1):76-82; discussion 83-85. 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. J Plast Reconstr Aesthet Surg. .newText { 1995;34(2):113-116. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Please check your insurance policy to see whether breast reduction is a covered procedure. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .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. 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. Surgeon. 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). No data were provided on loss to follow-up. The average age was 24.7 years (range of 18 to 47 years). Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Nguyen JT, Wheatley MJ, Schnur PL, et al. 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. A systematic search of the published literature was performed. background-color: #663399; Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. } Surgery. Rising Rates of Insurance Denial for Breast Reduction Surgery Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. background-color: #cc0066; padding-bottom: 4px; Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Plast Reconstr Surg. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Reduction mammoplasty improves symptoms of macromastia. A cohort study of breast cancer risk in breast reduction patients. Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). 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. 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. Plast Reconstr Surg. Breast reduction surgery - Mayo Clinic In a systematic review, these investigators examined the role of radiotherapy in this context. color: white; 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). } Computed tomography scan of adrenal glands to identify adrenal lesions. 1999;103(6):1687-1690. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. position: fixed; margin-bottom: 38px; Gynaecomastia. No other operation-related complications were observed. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . 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 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. Ann Plast Surg. Aesthetic Plast Surg. Oxford, UK: National Health Service (NHS); October 2008. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. 2001;108(6):1591-1599. 2007;356(5):479-485. 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. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. hr.separator { Br J Plast Surg. J Plast Surg Hand Surg. A non-standardized survey showed a very high satisfaction index. Plast Reconstr Surg. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com 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. 2021;147(5):1072-1083. Aesthet Plastic Surg. Refer to the member's specific plan document for applicable coverage. Well-designed clinical trials provide reliable information about the effectiveness of an intervention, and provide valid information about the characteristics of patients who would benefit from that intervention. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . } In other patients, excess skin and nipple and areola relocation are necessary. list-style-type : square !important; The nipple-areola complex was re-positioned in 60 % of patients (n = 54). The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. How to make Aetna pay for your breast reduction surgery Khan SM, Smeulders MJ, Van der Horst CM. Breast asymmetries: A brief review and our experience. Plastic Reconstruct Surg. 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. 2 . padding: 10px; Fischer S, Hirsch T, Hirche C, et al. outline: none; Subjects were compared to age-matched norms from another study cohort. Plast Reconstr Surg. 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. color:#eee; The authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). 2014b;48(5):334-339. 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). Quality of life after breast reduction. The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. Obstet Gynecol Clin North Am. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Aetna considers breast reconstructive surgery to correct Arlington Heights, IL: ASPS; 2011. Raispis T, Zehring RD, Downey DL. Kerrigan CL, Collins ED, Kneeland TS, et al. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. 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. 1997;185(6):593-603. Plast Reconstr Surg. 2019;8(4):431-440. Ann Plastic Surg. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. 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 Mannu GS, Sudul M, Bettencourt-Silva JH, et al. 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. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. 2006;118(4):840-848. Plast Reconstr Surg. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. 2015;49(6):311-318. #backTop:hover { First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. padding: 15px; From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. 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:. } list-style-type: upper-alpha; Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms.

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