Breast Reduction | American Society of Plastic Surgeons 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. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna 2012;130(4):785-789. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. J Plast Surg Hand Surg. Bertin ML, Crowe J, Gordon SM. 1998;49:215-234. What can I do if my insurance denies coverage for breast reduction? Ann Plast Surg. 2005;58(3):286-289. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Aesthetic Plast Surg. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Administration of Benefits and Transition Responsibilities These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. list-style-type: upper-alpha; 1. 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. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Ann Plast Surg. 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. 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. 2021;74(11):3128-3140. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Macromastia: all . Aetna considers breast reconstructive surgery to correct No data were provided on loss to follow-up. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Risk factors for complications following breast reduction: Results from a randomized control trial. Reduction mammoplasty: Cosmetic or reconstructive procedure? 1994;21(3):539-543. 2001;108(1):62-67. This may lead to additional scarring and additional operating time. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Reduction mammaplasty: Defining medical necessity. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Statistical analysis was performed with student t-test and chi-square test. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. } Gynecomastia: A systematic review. See Appendix for Table 1. } 2009;7(2):114-119. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Setala L, Papp A, Joukainen S, et al. Major complications (1.6 %) included unilateral hematoma and localized infection. Surgical treatment of primary gynecomastia in children and adolescents. No author listed. .newText { The end-point was the complete resolution of gynecomastia. Breast Concerns of Adolescents. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. 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 reduction outcome study. OL OL OL LI { 01/04/2023 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. 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). Prepubertal gynecomastia linked to lavender and tea tree oils. 2 . Recommended criteria for insurance coverage of reduction mammoplasty. #backTop { Plast Reconstr Surg. 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). Reduction mammoplasty for macromastia. Br J Plast Surg. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. 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). Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. 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. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Current concepts in gynaecomastia. } Plast Reconstr Surg. Reduction mammaplasty: An outcome study. text-decoration: underline; Plastic Reconstruct 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. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. .headerBar { 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. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. 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. 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. ol.numberedList LI { hr.separator { 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. Tang CL, Brown MH, Levine R, et al. Special Clinical Concerns. /* aetna.com standards styles for templates */ 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. Breast pumps. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Arlington Heights, IL: ASPS; 2011. Surgery. Ann Plastic Surg. } 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. Ann Chir Plast Esthet. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Copyright Aetna Inc. All rights reserved. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. @media print { Scand J Plast Reconstr Hand Surg. 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. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Management of gestational gigantomastia. 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. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. The authors stated that operative subjects were told that their responses to the questionnaire were not to be used for insurance and thus the subjects had no motivation to exaggerate symptoms prior to surgery in questionnaire responses; however, it is not clear whether operative subjects would be willing to submit responses to a questionnaire from the doctor that differed substantially from the history that they provided to the doctor during their preoperative evaluation. Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna How to Get Your Breast Reduction Covered By Insurance - RealSelf News 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. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. 1997;100(4):875-883. Surgeon. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). 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. How to make Aetna pay for your breast reduction surgery N Engl J Med. Policy. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. 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. Kerrigan CL, Collins ED, Kneeland TS, et al. Plast Reconstr Surg. 1993;17(3):211-223. Computed tomography scan of adrenal glands to identify adrenal lesions. Mistry RM, MacLennan SE, Hall-Findlay EJ. Mizgala CL, MacKenzie KM. 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. 1995;95(1):77-83. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. 2004;113(1):436-437. Magnetic Resonance Imaging (MRI) of the Breast - Aetna The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Am Surg. position: fixed; 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? Arlington Heights, IL: ASPS; March 9, 2002. Asian J Surg. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. 2017;139(6):1313-1322. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain.

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