aetna breast reduction requirementsselma times journal arrests
The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. @media print { 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. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Leclere FM, Spies M, Gohritz A, Vogt PM. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. And if you are in Canada the surgeon decides. In other patients, excess skin and nipple and areola relocation are necessary. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. 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. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. OL LI { Ann Plast Surg. outline: none; Many men with breast enlargement are found to have pseudo-gynecomastia. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. J Pediatr Surg. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. 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. Prepubertal gynecomastia linked to lavender and tea tree oils. list-style-type: upper-roman; Surgical treatment of primary gynecomastia in children and adolescents. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. 2019;166(5):934-939. 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: Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. } The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Plast Reconstr Surg. 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. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. 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. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. 2012;130(4):785-789. Socioeconomic Committee Position Paper. 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. 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 follow-up study of 105 women with breast cancer following reduction mammaplasty. 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. 2015;(10):CD007258. Aesthet Plastic Surg. Ann Chir Plast Esthet. Plastic Reconstr Surg. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. Reduction mammaplasty: Defining medical necessity. 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. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Plast Reconstr Surg. 1990;24(1):61-67. The health burden of breast hypertrophy. Current concepts in gynaecomastia. 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. Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. Aetna considers breast reconstructive surgery to correct The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. height:2px; 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. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Refer to the member's specific plan document for applicable coverage. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. top: 0px; Reduction mammaplasty: A review of managed care medical policy coverage criteria. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Breast cancer found at the time of breast reduction. 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. Abnormalities in Adolescent Breast Development. Plast Reconstr Surg. 2007;356(5):479-485. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. 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. 2006;118(4):840-848. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Surg Laparosc Endosc Percutan Tech. Laituri CA, Garey CL, Ostlie DJ, et al. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. 2008;32(1):38-44. Townsend: Sabiston Textbook of Surgery. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. 2018;7(Suppl 1):S70-S76. 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. #backTop { Gynecomastia. 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). However, it is unclear if there is any evidence to support this practice. Fischer S, Hirsch T, Hirche C, et al. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. 1993;91(7):1270-1276. Measuring health state preferences in women with breast hypertrophy. Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. The study subjects were stratified into groups based on ages of <60 years and 60 years. Plast Reconstr Surg. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. A total of 182 thirty-day postoperative surgical complications were documented, but stratifying patients into 2 age groups did not reveal an association between age and any surgical complication (P = .26). Risk factors for complications following breast reduction: Results from a randomized control trial. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Gynecomastia: Evolving paradigm of management and comparison of techniques. Chadbourne EB, Zhang S, Gordon MJ, et al. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. Also, there was no correlation between PR expression and 2D: 4D. Plast Reconstr Surg. } Treating providers are solely responsible for medical advice and treatment of members. Grooving where the bra straps sit on the shoulder. This investigators stated that these studies should include data from older individuals affected by gynecomastia and utilize valid tools of psychological measurement in order to better quantify the effect; elderly patients affected by the disease have been over-looked in the current research; more data on this subject could improve the pre-operative evaluation of these patients and help identify the patients who will benefit from treatment. 2nd ed. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. 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. Tang CL, Brown MH, Levine R, et al. All the patients recovered well and were satisfied with the cosmetic outcomes. GP Notebook. Raispis T, Zehring RD, Downey DL. Am J Infect Control. 2013;71(5):471-475. Arch Dis Child. Subjects were compared to age-matched norms from another study cohort. Horm Res Paediatr. .arrowPurpleSmall, a:hover.arrowPurpleSmall { /* aetna.com standards styles for templates */ 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). 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. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . 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. Plast Reconstr Surg. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. The author concluded that the current level of evidence on this subject was very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. 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). } Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). Kalliainen LK; ASPS Health Policy Committee. Howrigan P. Reduction and augmentation mammoplasty. 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). Gonzalez FG, Walton RL, Shafer B, et al. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Plastic Reconstr Surg. World J Surg. 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. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Women's Health and Cancer Rights Act of 1998. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Aesthetic Plast Surg. 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. Macromastia: all . The primary outcome was the difference in wound drainage over 24 hours. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. border: none; In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. 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). Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). color:#eee; breast augmentation with implant. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. The average age was 24.7 years (range of 18 to 47 years). 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. Philadelphia, PA: W.B. 2021;147(5):1072-1083. Disproportionately large breasts can cause both physical and emotional . text-decoration: underline; Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. } Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. cursor: pointer; The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Saunders Co.; 1991. However, these medications should be reserved for those with no decrease in breast size after 2 years. Plastic Reconstr Surg. z-index: 99; Plast Reconstr Surg. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. 2001;76(5):503-510. Determinants of surgical site infection after breast surgery. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. 2009;62(2):195-199. Burns JL, Blackwell SJ. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. 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. 2002;109(5):1556-1566. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Surgical treatment of gynecomastia: Complications and outcomes. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. 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. 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. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Plastic Reconstruct Surg. PLoS One. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended 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). 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. J Am Coll Surg. Gynecomastia is a very common concern of male adolescence. J Plast Surg Hand Surg. 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. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Tang CL, Brown MH, Levine R, et al. Kerrigan CL, Collins ED, Kim HM, et al. 2003;111(2):688-694. Level of Evidence = IV. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. 2000;106(5):991-997. Flancbaum L, Choban PS. Annu Rev Med. padding: 15px; The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Breast pumps. Reduction mammoplasty: Cosmetic or reconstructive procedure? color: white; 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:. Gynecomastia in patients with prostate cancer: A systematic review. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Obesity and complications in breast reduction surgery: Are restrictions justified? color: red!important; Resolution of idiopathic gynecomastia may take several months to years. Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. A total of 244 out of 1,628 patients with the average age of 23.13 years. Gland Surg. Type II gynecomastia is more generalized breast enlargement. 2001;107(5):1234-1240. 2018;89(6):408-412. list-style-type: upper-alpha; Schnur PL, Hoehn JG, Ilstrup DM, et al. Thus, more than 1/3of operative subjects selected for inclusion in the study did not complete it; most of the operative subjects who did not complete the study were lost to follow-up. 2007;119(4):1159-1166. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Reduction mammoplasty for asymptomatic members is considered cosmetic. 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 Ann Plastic Surg. Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. 2015;49(6):311-318. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. 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]. 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. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Mental health care professionals may be consulted to address psychological distress from gynecomastia. A physician-supervised diet and exercise plan may be indicated in obese patients. OL OL OL LI { The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Emiroglu M, Salimoglu S, Karaali C, et al. 1995;61(11):1001-1005. 2004;113(1):436-437. 2008;61(5):493-502. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. } Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? Plast Reconstr Surg. hr.separator { text-decoration: line-through; Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. 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. J Plast Surg Hand Surg. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. } The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications.
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aetna breast reduction requirements