Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Laituri CA, Garey CL, Ostlie DJ, et al. 2018;7(Suppl 1):S70-S76. For individuals who received radiation treatment to the chest . @media print {
Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Surgical treatment of primary gynecomastia in children and adolescents. 2010;125(5):1301-1308. Plastic Reconstruct Surg. PLoS One. This will be computed based on your body area.
Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna 2000;45(6):575-580. Gonzalez FG, Walton RL, Shafer B, et al. 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). Burns JL, Blackwell SJ. color: red!important; Gynecomastia may be drug-induced. Plast Reconstr Surg. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. ASPS clinical practice guideline summary on reduction mammaplasty. /*margin-bottom: 43px;*/ 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.
Breast reduction surgery - Mayo Clinic For many patients the psychological impact of the disease is substantial. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Reduction mammaplasty: Defining medical necessity. 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:. Another set of breast pump supplies if you get pregnant . Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Aetna considers breast reconstructive surgery to correct The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Cochrane Database Syst Rev. Surgical implications of obesity. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Annu Rev Med. 01/04/2023 Breast pumps.
Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare 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. 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. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects.
PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. In a systematic review, these investigators examined the role of radiotherapy in this context. 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. 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. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Gynecomastia in patients with prostate cancer: Update on treatment options. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. A total of 90 patients underwent breast re-reduction surgery. Risk factors for complications following breast reduction: Results from a randomized control trial. 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. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). Breast reduction outcome study. } Prostate Cancer Prostatic Dis. cursor: pointer; 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). Abnormalities in Adolescent Breast Development. Plast Reconstr Surg. 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. Ann Plast Surg. 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. Breast cancer found at the time of breast reduction. Gland Surg. High-risk lesions (atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], and lobular carcinoma in situ [LCIS]) were revealed in 37 (11.7 %), and cancer in 6 (1.9 %) patients. Reduction mammaplasty: The need for prospective randomized studies. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. 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". Li CC, Fu JP, Chang SC, et al. 2001;107(5):1234-1240. list-style-type: upper-roman;
Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Brown MH, Weinberg M, Chong N, et al. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. 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. 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 . Mizgala CL, MacKenzie KM. Ann Plast Surg. Principles of breast re-reduction: A reappraisal. 2017;35:157-161. 2002;109(5):1556-1566. display: block; Fagerlund A, Cormio L, Palangi L, et al. 2006;30(3):309-319. Long-term functional results after reduction mammoplasty. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. 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. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Recommended criteria for insurance coverage of reduction mammoplasty. Am Surg. Aesthet Surg J. Determinants of surgical site infection after breast surgery. Med Decis Making. J Pediatr Surg. 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. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. 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. Setala L, Papp A, Joukainen S, et al. The study subjects were stratified into groups based on ages of <60 years and 60 years. } 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. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. } Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. } 2021 Aug 11 [Online ahead of print]. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT.
Breast Reduction | American Society of Plastic Surgeons J Plast Surg Hand Surg. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Plast Reconstr Surg. .fixedHeaderWrap { Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Reduction mammoplasty: Criteria for insurance coverage. Arch Dis Child. 2006;9(2):109-114. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. J Am Coll Surg. Ann Plast Surg.
PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com color: blue 2005;58(3):286-289. 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. 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]). 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., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Petty PM, Solomon M, Buchel EW, Tran NV. 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. The primary outcome was the difference in wound drainage over 24 hours. 2000;106(2):280-288. This Clinical Policy Bulletin may be updated and therefore is subject to change. Gynecomastia: A systematic review. The majority (87.7 %) of cases presented with accompanying mastalgia. The mean age was 42.8 years (SD 19.5 years). 2015;10(8):e0136094. 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. 2009;19(3):e85-e90. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. color: white; 2014a;34(3):409-416. Ann Plast Surg. Coding 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. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. .strikeThrough { Marshall WA, Tanner JM. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. 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. Kerrigan CL, Collins ED, Striplin D, et al. Breast and aesthetic surgery. Breast. Evidence-based clinical practice guideline: Reduction mammaplasty. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). (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. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. Plast Reconstr Surg. background: #5e9732; The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Breast asymmetries: A brief review and our experience. border-radius: 4px; American Society of Plastic and Reconstructive Surgery (ASPRS). Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. 2007;36(2):497-519. Sugrue CM, McInerney N, Joyce CW, et al. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. A physician-supervised diet and exercise plan may be indicated in obese patients. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Breast J. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Khan SM, Smeulders MJ, Van der Horst CM. and areola. Level of Evidence = IV. Please check your insurance policy to see whether breast reduction is a covered procedure. 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. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. .strikeThrough { Plastic Reconstr 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. Gynecomastia: Evolving paradigm of management and comparison of techniques. Kasielska-Trojan A, Danilewicz M, Antoszewski B. list-style-type: upper-alpha; The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Krieger LM, Lesavoy MA. Resolution of idiopathic gynecomastia may take several months to years. Araco A, Gravante G, Araco F, et al. 2015;75(4):370-375. In the case of reduction mammoplasty for relief of back, neck and shoulder pain, Aetna has considered this procedure medically necessary in women with excessively large breasts because it seems logical, even in the absence of firm clinical trial evidence, that this excessive weight would contribute to back and shoulder pain, and that removal of this excessive breast tissue would provide substantial pain relief, reductions in disability, and improvements in function. Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases?
Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Flancbaum L, Choban PS. He Q, Zheng L, Zhuang D, et al. Miller AP, Zacher JB, Berggren RB, et al. The average age was 24.7 years (range of 18 to 47 years). Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. z-index: 99; 1999;103(6):1687-1690. background-position: right 65%; Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 2020 Sep 4 [Online ahead of print]. Aesthetic Plast Surg. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Analysis was on an intention-to-treat basis. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Ages ranged from 18 to 66 years. li.bullet { Ann Plastic Surg. padding: 15px; GP Notebook. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. 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: color:#eee; Pain/discomfort/ulceration from bra straps cutting into shoulders; Skin breakdown (severe soft tissue infection, tissue necrosis, ulceration hemorrhage) from overlying breast tissue; There is a reasonable likelihood that the member's symptoms are primarily due to macromastia; Reduction mammoplasty (also spelled as 'mammaplasty') is likely to result in improvement of the chronic pain; Pain symptoms persist as documented by the physician despite at least a 3-month trial of therapeutic measures such as: Analgesic/non-steroidal anti-inflammatory drugs (NSAIDs) interventions and/or muscle relaxants, Dermatologic therapy of ulcers, necrosis and refractory infection, Physical therapy/exercises/posturing maneuvers, Supportive devices (e.g., proper bra support, wide bra straps), Chiropractic care or osteopathic manipulative treatment. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. height:2px; All studies on the subject were evaluated for inclusion and 6 studies were included in the review. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients.
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