Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. 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. 2015;49(6):311-318. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Washington, DC: ACOG; 2011:121-122. Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. 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. } Arlington Heights, IL: ASPS; May 2011. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Long-term functional results after reduction mammoplasty. text-decoration: line-through; Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. padding: 10px; Breast and aesthetic surgery. PLoS One. Obstet Gynecol Clin North Am. 2009;7(2):114-119. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. All patients underwent routine investigations to exclude secondary causes of gynecomastia. 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. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. 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). 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. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. Handschin AE, Bietry D, Hsler R, et al. Plast Reconstr Surg. background-color: #cc0066; Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. z-index: 99; } Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Other just require 500 grams no matter what your height and weight. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. J Plast Surg Hand Surg. Breast J. hr.separator { Narula HS, Carlson HE. .headerBar { J Plast Surg Hand Surg. } J Plast Surg Hand Surg. Ann Plast Surg. Abnormalities in Adolescent Breast Development. Plast Reconstr Surg. Administration of Benefits and Transition Responsibilities Plast Reconstr Surg. Arlington Heights, IL: ASPS; March 9, 2002. Collins ED, Kerrigan CL, Kim M, et al. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. Breast reduction for symptomatic macromastia. 01/04/2023 For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. 1999;103(6):1674-1681. Kerrigan CL, Collins ED, Kneeland TS, et al. 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. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. The Mammotome procedure represented another novel therapeutic option for gynecomastia. Ann Plast Surg. In the case of breast reduction, however, for insurance purposes, it . color: blue Burdette TE, Kerrigan CL, Homa KA. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. For medical Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. There were only 2 studies of a total 25 patients that were considered as good in quality. OL OL OL LI { It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Breast reduction surgery - Mayo Clinic Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. Level of Evidence = III. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. } Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Ann Plast Surg. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Nguyen JT, Wheatley MJ, Schnur PL, et al. Computed tomography scan of adrenal glands to identify adrenal lesions. Level of Evidence = IV. Aesthet Plastic Surg. Plastic Reconstruct Surg. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna 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. OL OL LI { 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. Reduction mammaplasty: A review of managed care medical policy coverage criteria. J Pediatr Surg. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Petty PM, Solomon M, Buchel EW, Tran NV. 2006;9(2):109-114. Principles of breast re-reduction: A reappraisal. Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. PDF Gender Dysphoria Treatment - Cigna Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . American Society of Plastic Surgeons (ASPS). Lonie S, Sachs R, Shen A, et al. 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. 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]). Schnur PL, Schnur DP, Petty PM, et al. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Gynecomastia. Please check your insurance policy to see whether breast reduction is a covered procedure. Fischer S, Hirsch T, Hirche C, et al. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. 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. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. The health burden of breast hypertrophy. 2000;106(5):991-997. However, it is unclear if there is any evidence to support this practice. 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. Determinants of surgical site infection after breast surgery. 2015;49(6):363-366. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. of the following criteria must be met: Laituri CA, Garey CL, Ostlie DJ, et al. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Blomqvist L, Eriksson A, Brandberg Y. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Endocrinol Metab Clin North Am. Three review authors undertook independent screening of the search results. Gland Surg. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. 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. If an insufficient amount of breast tissue is removed, the surgery is less likely to be successful in relieving pain and any related symptoms from excessive breast weight (e.g., excoriations, rash). Brown MH, Weinberg M, Chong N, et al. Krieger LM, Lesavoy MA. How to Get Your Breast Reduction Covered By Insurance - RealSelf News Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). } For many patients the psychological impact of the disease is substantial. Mizgala CL, MacKenzie KM. Gynecomastia may be drug-induced. Arlington Heights, IL: ASPRS; 1987. Analysis was on an intention-to-treat basis. 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). Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. 1995;95(6):1029-1032. Links to various non-Aetna sites are provided for your convenience only. 2018;7(Suppl 1):S70-S76. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Breast Reduction Surgery | Johns Hopkins Medicine 1999;103(1):76-82; discussion 83-85. Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. 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. 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). However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Sood R, Mount DL, Coleman JJ 3rd, et al. .strikeThrough { Women's Health and Cancer Rights Act of 1998. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. These preliminary findings need to be validated by well-designed studies. # color: white; Statistical analysis was performed with student t-test and chi-square test. 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 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. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes.
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