aetna breast reduction requirements

margin-bottom: 38px; Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. 1990;24(1):61-67. All the patients recovered well and were satisfied with the cosmetic outcomes. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. } text-decoration: underline; Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Patient demographics, surgical technique, and outcomes were analyzed. 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). width: 100%; Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 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. Principles of breast re-reduction: A reappraisal. } 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. position: fixed; Level of Evidence = IV. 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. Plastic Reconstr Surg. 18th ed. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Breast J. 1996;20(5):391-397. Plast Reconstr Surg. Howrigan P. Reduction and augmentation mammoplasty. A total of 90 patients underwent breast re-reduction surgery. Plast Reconstr Surg. A population-level analysis of bilateral breast reduction: does age affect early complications? 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. You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. 1995;95(6):1029-1032. 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. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. .strikeThrough { 2014a;34(3):409-416. }. 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 authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Type II gynecomastia is more generalized breast enlargement. Ages ranged from 18 to 66 years. top: 0px; Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Araco A, Gravante G, Araco F, et al. 2015;49(6):311-318. Priorities Forum Policy Statement. A detailed physical examination, including testicular examination. A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. Reduction mammoplasty for asymptomatic members is considered cosmetic. See Appendix for Table 1. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Risk of bias was assessed independently by 2review authors. Ann Plast Surg. 2014;20(3):274-278. 1993;91(7):1270-1276. Plast Reconstr Surg. With approval from the authors institutional ethics committee and written informed consent, a total of 22 patients with 33 abnormally hyperplastic breasts were enrolled at the First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Obesity and complications in breast reduction surgery: Are restrictions justified? } 1995;34(2):113-116. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. 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". Arlington Heights, IL: ASPS; March 9, 2002. Many men with breast enlargement are found to have pseudo-gynecomastia. And if you are in Canada the surgeon decides. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Seitchik MW. The Breast: Comprehensive Management of Benign and Malignant Diseases. 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. Current concepts in gynaecomastia. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. GP Notebook. 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. The end-point was the complete resolution of gynecomastia. 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. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Major complications (1.6 %) included unilateral hematoma and localized infection. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. list-style-type: decimal; Plast Reconstr Surg. Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. right: 30px; A total of 81 patients were included in this study. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. list-style-type: upper-roman; Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. These preliminary findings need to be validated by well-designed studies. Plast Reconstr Surg. N Engl J Med. Petty PM, Solomon M, Buchel EW, Tran NV. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Another set of breast pump supplies if you get pregnant . Fagerlund A, Lewin R, Rufolo G, et al. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Socioeconomic Committee Position Paper. Devalia HL, Layer GT. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. Reduction mammoplasty: Cosmetic or reconstructive procedure? Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. 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. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. 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. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. 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. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Risk factors for complications following breast reduction: Results from a randomized control trial. Raispis T, Zehring RD, Downey DL. breast augmentation with implant. Kalliainen LK; ASPS Health Policy Committee. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. (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. 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). Plast Reconstr Surg. 2017;139(6):1313-1322. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. 2004;113(1):436-437. 2010;125(5):1301-1308. There were 18 out of 415 studies eligible to review. cursor: pointer; Lonie S, Sachs R, Shen A, et al. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. border: none; Breast reduction outcome study. 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. Variations in pattern of pubertal changes in girls. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. 2015;75(4):383-387. In a review on Surgical treatment of primary gynecomastia in children and adolescents, Fischer et al (2014b) concluded that surgical correction of gynecomastia remains a purely elective intervention. Aesthet Plastic 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. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Fischer JP, Cleveland EC, Shang EK, et al. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Plast Reconstr Surg. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 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). Ann Chir Plast Esthet. padding-right: 18px; Other just require 500 grams no matter what your height and weight. Special Clinical Concerns. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Surgical treatment of primary gynecomastia in children and adolescents. Plast Reconstr Surg. Yao Y, Yang Y, Liu J, et al. Aesthetic Plast Surg. Plast Reconstr Surg. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. PLoS One. Guidelines for Adolescent Health Care. # font-weight: bold; li.bullet { outline: none; Li CC, Fu JP, Chang SC, et al. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. } Secondary outcomes included subjective as well as objective assessments of pain and wound healing. A total of 15 articles met the inclusion criteria for review. This will be computed based on your body area. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). color:#eee; Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. 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 . Bland KI, Copeland EM, eds. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Breast and aesthetic surgery. 2000;106(5):991-997. Sood R, Mount DL, Coleman JJ 3rd, et al. 2002;33:208-217. 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. In the case of breast reduction, however, for insurance purposes, it . Well-designed trials are especially important in assessing pain management interventions to isolate the contribution of the intervention from placebo effects, the effects of other concurrently administered pain management interventions, and the natural history of the medical condition. #closethis { 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. 1998;101(2):361-364. 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). .newText { Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. 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.

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