2014;20(3):274-278. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. 2015;49(6):311-318. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. Many men with breast enlargement are found to have pseudo-gynecomastia. A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. OL OL OL LI { Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. 2014b;48(5):334-339. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. 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. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. cursor: pointer; Refer to the member's specific plan document for applicable coverage. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. color: blue } Laituri CA, Garey CL, Ostlie DJ, et al. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). 1990;24(1):61-67. Ann Chir Plast Esthet. li.bullet { 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. Quality of life after breast reduction. 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. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. All RCTs that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. border: none; Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. 2019;166(5):934-939. Disproportionately large breasts can cause both physical and emotional . } 1999;103(6):1682-1686. Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). 2006;118(4):840-848. 2007;36(2):497-519. The authors (Nguyen et al, 2004) argue, based primarily on the results of the ASPS-funded BRAVO study (described below), that (with a single exception) no objective criteria for breast reduction surgery are supportable, including criteria based upon the presence of particular signs or symptoms, requirements based upon breast size or the amount of breast tissue removed, any minimum age limitations, any limitation based upon maximum body weight, requirements for a trial of conservative therapy, or the exclusion of certain procedures (liposuction). 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. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Arlington Heights, IL: ASPS; May 2011. Saunders Co.; 1991. You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. 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. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Aesthet Surg J. } 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). And if you are in Canada the surgeon decides. bottom: 20px; J Plast Reconstr Aesthet Surg. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. 2021;74(11):3128-3140. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Gonzalez FG, Walton RL, Shafer B, et al. Last Review01/04/2023. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. .newText { } In other patients, excess skin and nipple and areola relocation are necessary. In a systematic review, these investigators examined the role of radiotherapy in this context. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). For individuals who received radiation treatment to the chest . In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Khan SM, Smeulders MJ, Van der Horst CM. 1995;61(11):1001-1005. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. 1999;103(6):1687-1690. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. 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 J Plast Reconstr Aesthet Surg. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. 01/04/2023 Breast Concerns of Adolescents. Policy Statement 6d: Aesthetic surgery procedures. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. No data were provided on loss to follow-up. 2006;30(3):309-319. padding: 15px; Can objective predictors for operative success be identified? 2010;45(3):650-654. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. 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. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Level of Evidence = IV. list-style-type: upper-alpha; Links to various non-Aetna sites are provided for your convenience only. Ann Plast Surg. GP Notebook. 2006;9(2):109-114. 2003;111(2):688-694. 1999;103(1):76-82; discussion 83-85. 2 . Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. color: red!important; A follow-up study of 105 women with breast cancer following reduction mammaplasty. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. hr.separator { Patient demographics, surgical technique, and outcomes were analyzed. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Mayo Clin Proc. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. color:#eee; The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Breast and aesthetic surgery. 1995;95(1):77-83. Br J Plast Surg. Reduction mammoplasty improves symptoms of macromastia. Howrigan P. Reduction and augmentation mammoplasty. Socioeconomic Committee Position Paper. Level of Evidence = III. Endocrinol Metab Clin North Am. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. #backTop { Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. 2009;19(3):e85-e90. Gynecomastia may be drug-induced. Ann Plast Surg. Devalia HL, Layer GT. Also, there was no correlation between PR expression and 2D: 4D. Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). 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. A non-standardized survey showed a very high satisfaction index. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Surgical implications of obesity. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. J Plast Surg Hand Surg. .headerBar { Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Gynecomastia in patients with prostate cancer: Update on treatment options. 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. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. Pediatr Surg Int. No new trials were identified for this first update. Reduction mammaplasty: The need for prospective randomized studies. and areola. } Gynaecomastia. There were no restrictions on the basis of date or language of publication. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. American Society of Plastic Surgeons (ASPS). 2005;58(3):286-289. } Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? } Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy. 2000;106(2):280-288. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Ann Plastic 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. In these cases, breast reduction for men may take 2 to 3 hours. Petty PM, Solomon M, Buchel EW, Tran NV. Reduction mammoplasty for asymptomatic members is considered cosmetic. Copyright Aetna Inc. All rights reserved. background-color:#eee; Type II gynecomastia is more generalized breast enlargement. Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. 2009;62(2):195-199. 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. Handschin AE, Bietry D, Hsler R, et al. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. ol.numberedList LI { Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. .fixedHeaderWrap { Sood R, Mount DL, Coleman JJ 3rd, et al. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). 2008;61(5):493-502. Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. 2015;75(4):370-375. 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). All the patients recovered well and were satisfied with the cosmetic outcomes. 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). However, these medications should be reserved for those with no decrease in breast size after 2 years. Plastic surgery for teenagers briefing paper. Aesthet Plastic Surg. 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. Surgeon. list-style-type: lower-roman; Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). 2008;32(1):38-44. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. 2001;108(6):1591-1599. OL OL LI { 1997;185(6):593-603. # font-weight: bold; J Plast Reconstr Aesthet Surg. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Plast Reconstr Surg. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. ASPS Recommended Coverage Criteria for Third Party Payors. To get insurance coverage, you'll probably need . 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. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. color: #FFF; (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. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Yao Y, Yang Y, Liu J, et al. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. list-style-type: decimal; Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Bland KI, Copeland EM, eds. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. 2010;125(5):1301-1308. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Kalliainen LK; ASPS Health Policy Committee. 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). 2018;7(Suppl 1):S70-S76.