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. A non-standardized survey showed a very high satisfaction index. Gynecomastia: Evolving paradigm of management and comparison of techniques. Emiroglu M, Salimoglu S, Karaali C, et al. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. 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. Aetna considers breast reconstructive surgery to correct American Society of Plastic Surgeons (ASPS). 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. Raispis T, Zehring RD, Downey DL. 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:. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. 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). Plast Reconstr Surg. Quality of life after breast reduction. 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). Kerrigan CL, Collins ED, Striplin D, et al. Reduction mammaplasty provides long-term improvement in health status and quality of life. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. 2015;49(6):363-366. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. In a systematic review, these investigators examined the role of radiotherapy in this context. How to Get Your Breast Reduction Covered By Insurance - RealSelf News Breast. } 2014b;48(5):334-339. Administration of Benefits and Transition Responsibilities Computed tomography scan of adrenal glands to identify adrenal lesions. Level of Evidence = IV. Cochrane Database Syst Rev. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. 1995;34(2):113-116. Wound drainage after plastic and reconstructive surgery of the breast. 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. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). The condition not only must be unresponsive to dermatological treatments (e.g., antibiotics or antifungal therapy) and conservative measures (e.g., good skin hygiene, adequate nutrition) for a period of 6 months or longer, but also must satisfy criteria stated insection I above. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Plast Reconstr Surg. 01/04/2023 1995;61(11):1001-1005. Often times, insurance company will dictate how much breast tissue to be removed. 2015;49(6):311-318. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Washington, DC: ACOG; 2011:121-122. Yao Y, Yang Y, Liu J, et al. J Plast Reconstr Aesthet Surg. 2018;24(6):1043-1045. J Laparoendosc Adv Surg Tech A. Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. 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). Ann Plastic Surg. Collins ED, Kerrigan CL, Kim M, et al. list-style-type: lower-alpha; Aesthetic Plast Surg. 2006;9(2):109-114. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. Plast Reconstr Surg. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. PDF Procedures, programs and drugs you must precertify - AmeriBen 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. No statistically significant differences in the drainage, level of pain, size of open areas, clinical appearance, degree of scar pliability, or scar erythema were noted. J Am Coll Surg. Breast pumps. A total of 90 patients underwent breast re-reduction surgery. Ann Plast Surg. 2005;58(3):286-289. Level of Evidence = IV. 2021;147(5):1072-1083. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. color:#eee; 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. Krieger LM, Lesavoy MA. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. 1997;100(4):875-883. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. text-decoration: underline; Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. 1998;49:215-234. Collis N, McGuiness CM, Batchelor AG. 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. color: red 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. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Reduction mammoplasty improves symptoms of macromastia. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. Glatt BS, Sarwer DB, O'Hara DE, et al. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 2008;121(4):1092-1100. Aesthetic Plast Surg. A study by Bruhlmann and Tschopp (1998) was a retrospective study of 246 patients from a surgical practice, approximately 50 % (132) of whom returned a questionnaire about their symptoms and satisfaction with aesthetic results, and their recollection of symptoms prior to surgery. Links to various non-Aetna sites are provided for your convenience only. 40 . Oxford, UK: National Health Service (NHS); October 2008. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. 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). 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. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Petty PM, Solomon M, Buchel EW, Tran NV. 2007;119(4):1159-1166. The end-point was the complete resolution of gynecomastia. Statistical analysis was performed with student t-test and chi-square test. Plast Reconstr Surg. Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com 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. For medical Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. ol.numberedList LI { Measuring health state preferences in women with breast hypertrophy. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. No data were provided on loss to follow-up. OL OL OL OL LI { Marshall WA, Tanner JM. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Gynecomastia is a very common concern of male adolescence. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; American Society of Plastic Surgeons (ASPS). Breast reduction for symptomatic macromastia. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. color: #FFF; Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). } 1998;26(1):61-65. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. --> 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 mammaplasty. 2014b;30(6):641-647. Arlington Heights, IL: ASPS; March 9, 2002. 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. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. 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. Oxfordshire NHS Trust. Laituri CA, Garey CL, Ostlie DJ, et al. hr.separator { Current concepts in gynaecomastia. Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. OL OL OL LI { Disproportionately large breasts can cause both physical and emotional . Special Clinical Concerns. 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. Breast Reduction Surgery | Johns Hopkins Medicine The health burden of breast hypertrophy. 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. Plastic surgery for teenagers briefing paper. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. .strikeThrough { 1999;103(1):76-82; discussion 83-85. The authorsleave the reader with the conclusionthat decisions about the medical necessity of breast reduction surgery in symptomatic women should be left entirely to the surgeon's discretion. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. Burdette TE, Kerrigan CL, Homa KA. Arlington Heights, IL: ASPS; May 2011. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Other just require 500 grams no matter what your height and weight. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). 1995;95(1):77-83. 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]. Mayo Clin Proc. Scand J Plast Reconstr Hand Surg. Women's Health and Cancer Rights Act of 1998. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. 1999;103(6):1687-1690. 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. J Plast Surg Hand Surg. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Gonzalez FG, Walton RL, Shafer B, et al. 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. #closethis { Breast reduction surgery - Mayo Clinic Ann Plast Surg. What can I do if my insurance denies coverage for breast reduction? Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Reduction mammaplasty: The need for prospective randomized studies. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). 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. Bertin ML, Crowe J, Gordon SM. Ann Plast Surg. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . J Plast Surg Hand Surg. 2002;33:208-217. padding: 10px; Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. 2017;35:157-161. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Plastic Reconstruct Surg. OL OL OL OL OL LI { width: 100%; Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. 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. Surg Laparosc Endosc Percutan Tech. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Determinants of surgical site infection after breast surgery. 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; 2011. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. A total of 81 patients were included in this study. 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 . This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Asian J Surg. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size.