The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. 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. 2008;53(3):255-261. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Devalia HL, Layer GT. Aesthetic Plast Surg. Surgical treatment is indicated when medical treatments fail. However, these medications should be reserved for those with no decrease in breast size after 2 years. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. 2000;106(5):991-997. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. 1990;24(1):61-67. Brown MH, Weinberg M, Chong N, et al. 2004;113(1):436-437. This will be computed based on your body area. Sabistons Textbook of Surgery (Burns & Blackwell, 2008)states that breast size should be stable for one year: There is no set lower age limit but, for the adolescent with breast hypertrophy, reduction is deferred until the breasts have stopped growing and are stable in size for at least 12 months before surgery.. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. A total of 244 out of 1,628 patients with the average age of 23.13 years. color: white; All studies on the subject were evaluated for inclusion and 6 studies were included in the review. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). } Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. 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. background-color: #cc0066; Breast. Gland Surg. Socioeconomic Committee Position Paper. 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. 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 . Plast Reconstr Surg. color: red!important; Schnur PL, Hoehn JG, Ilstrup DM, et al. All the patients recovered well and were satisfied with the cosmetic outcomes. 2019;166(5):934-939. 2002;109(5):1556-1566. 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. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Plastic Reconstruct Surg. N Engl J Med. z-index: 99; color: red Treatment of adolescent gynecomastia. For medical Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Nguyen JT, Wheatley MJ, Schnur PL, et al. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. No author listed. 2007;356(5):479-485. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . Ann Plast Surg. Raispis T, Zehring RD, Downey DL. Krieger LM, Lesavoy MA. --> Ann Plast Surg. Aesthet Surg J. J Plast Surg Hand Surg. Disproportionately large breasts can cause both physical and emotional . J Plast Reconstr Aesthet Surg. 2005;58(3):286-289. Copyright Aetna Inc. All rights reserved. Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). Nelson et al (2014b) separately conducted a population level analysis of the 2005-2011 NSQIP datasets, identifying patient who underwent reduction mammoplasty, to determine the impact of obesity on early complications after reduction mammoplasty. right: 30px; Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. 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. /* aetna.com standards styles for templates */ Level of Evidence = IV. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Ann Chir Plast Esthet. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. A follow-up study of 105 women with breast cancer following reduction mammaplasty. Breast J. border-radius: 4px; Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Arlington Heights, IL: ASPS; May 2011. Quality of life after breast reduction. Philadelphia, PA: W.B. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. text-decoration: line-through; 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. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. 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. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Plast Reconstr Surg. Sugrue CM, McInerney N, Joyce CW, et al. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Breast cancer found at the time of breast reduction. A systematic search of the published literature was performed. Fagerlund A, Cormio L, Palangi L, et al. You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. Level of Evidence = IV. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; 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. list-style-type: upper-roman; The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. Br J Plast Surg. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. breast augmentation with implant. Reduction mammaplasty: A review of managed care medical policy coverage criteria. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. .headerBar { Tang CL, Brown MH, Levine R, et al. skin should not be excised horizontally below the inframammary fold. 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. Reduction mammoplasty for macromastia. #backTop { 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). And if you are in Canada the surgeon decides. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Collins ED, Kerrigan CL, Kim M, et al. The authors concluded that breast re-reduction can be performed safely and predictably, even when the previous technique is not known; and 4 key principles were developed: Language services can be provided by calling the number on your member ID card. These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio). Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Arlington Heights, IL: ASPRS; 1987. Treating providers are solely responsible for medical advice and treatment of members. Fischer JP, Cleveland EC, Shang EK, et al. 2012;69(5):510-515. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). } Please check your insurance policy to see whether breast reduction is a covered procedure. 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. 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: The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Risk of bias was assessed independently by 2review authors. Obstet Gynecol Clin North Am. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. To get insurance coverage, you'll probably need . 2018;7(Suppl 1):S70-S76. 2002;33:208-217. Plast Reconstr Surg. 2014b;30(6):641-647. Townsend: Sabiston Textbook of Surgery. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Subjects were compared to age-matched norms from another study cohort. 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). The following procedures are considered experimental and investigational because there is insufficient evidence of itseffectiveness or itseffectiveness has not been established: Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. Reduction mammoplasty improves symptoms of macromastia. 2021 Aug 11 [Online ahead of print]. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. 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. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Plastic Reconstruct Surg. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. OL LI { the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. 2008;32(1):38-44. Bertin ML, Crowe J, Gordon SM. } margin-bottom: 38px; list-style-type : square !important; 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. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. 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. The mean age was 42.8 years (SD 19.5 years). Other just require 500 grams no matter what your height and weight. 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. 1999;103(6):1687-1690. Plast Reconstr Surg. Recommended criteria for insurance coverage of reduction mammoplasty. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. Plast Reconstr Surg. 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. 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. color: #FFF; 2001;76(5):503-510. 2017;139(6):1313-1322. cursor: pointer; Ann Plast Surg. }. 1999;103(6):1674-1681. American Society of Plastic and Reconstructive Surgery (ASPRS). border: none; Sood R, Mount DL, Coleman JJ 3rd, et al. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 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. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Current concepts in gynaecomastia. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. 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. These preliminary findings need to be validated by well-designed studies. Mizgala CL, MacKenzie KM. Am Surg. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Ann Plast Surg. 2009;62(2):195-199. .strikeThrough { Saunders Co.; 1991. Brown DM, Young VL. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. This may lead to additional scarring and additional operating time. 2015;10(8):e0136094. 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]). This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Hoyos AE, Perez ME, Dominguez-Millan R, et al. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. The study subjects were stratified into groups based on ages of <60 years and 60 years. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). 2010;125(5):1301-1308. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Leclere FM, Spies M, Gohritz A, Vogt PM.
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