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. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Abnormal histopathological findings were more frequent in patients with reduction mammoplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Handschin AE, Bietry D, Hsler R, et al. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 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:. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Surgical treatment of gynecomastia: Complications and outcomes. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. 2000;106(2):280-288. Ann Plast Surg. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? J Laparoendosc Adv Surg Tech A. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. 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.
PDF Gender Dysphoria Treatment - Cigna 1991;27(3):232-237. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. 2008;53(3):255-261. 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: Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . There were 18 out of 415 studies eligible to review. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Howrigan P. Reduction and augmentation mammoplasty. Plastic Reconstr Surg. }. Gynecomastia may be drug-induced. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Gynecomastia. Management of gestational gigantomastia. } ol.numberedList LI { They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Coding outline: none; Surg Laparosc Endosc Percutan Tech. 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. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Plast Reconstr Surg. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. Prepubertal gynecomastia linked to lavender and tea tree oils. 2016;20(3):256-260. No new trials were identified for this first update. As explained below, the studies used to support the arguments for the medical necessity of breast reduction surgery are poorly controlled and therefore subject to a substantial risk of bias in the interpretation of results. 2014b;30(6):641-647. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. In a systematic review, these investigators examined the role of radiotherapy in this context. 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. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. 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). 1999;103(1):76-82; discussion 83-85. Reduction mammaplasty: Defining medical necessity. .newText { Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. The study subjects were stratified into groups based on ages of <60 years and 60 years. Refer to the member's specific plan document for applicable coverage. Plastic Reconstruct Surg. } For individuals who received radiation treatment to the chest . Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. 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. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Risk of bias was assessed independently by 2review authors. Last Review01/04/2023.
What are Aetna breast reduction requirements? - RealSelf.com 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
Breast Reduction Surgery | Johns Hopkins Medicine color: blue!important; Ann Plast Surg. Another set of breast pump supplies if you get pregnant . Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Recommended criteria for insurance coverage of reduction mammoplasty. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Laituri CA, Garey CL, Ostlie DJ, et al. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. For many patients the psychological impact of the disease is substantial. 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). } 2005;58(3):286-289. Quality of life after breast reduction. A total of 244 out of 1,628 patients with the average age of 23.13 years. 2011;128(4):243e-249e. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. In these cases, breast reduction for men may take 2 to 3 hours. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Because reduction mammoplasty may be used for both medically necessary and cosmetic indications, Aetna has set forth above objective criteria to distinguish medically necessary reduction mammoplasty from cosmetic reduction mammoplasty. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). 40 . Mistry RM, MacLennan SE, Hall-Findlay EJ. 2021;74(11):3128-3140. Narula HS, Carlson HE. 2015;49(6):311-318. Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. 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. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. Kasielska-Trojan A, Danilewicz M, Antoszewski B. } 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.
CG-SURG-71 Reduction Mammaplasty - Anthem PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Plast Reconstr 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. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). #backTop { Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. 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. } 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. Surgical management of gynecomastia--a 10-year analysis. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age.
Does Health Insurance Cover Breast Reduction Surgery? - GoodRx Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Pediatr Surg Int. list-style-type: decimal;
Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Ann Chir Plast Esthet. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Administration of Benefits and Transition Responsibilities N Engl J Med. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Breast. 2009;19(3):e85-e90. 2001;108(6):1591-1599.