Breast 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). } Copyright Aetna Inc. All rights reserved. Aetna considers breast reconstructive surgery to correct Ann Chir Plast Esthet. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). 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). Macromastia: all . 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. Qu S, Zhang W, Li S, et al. Surgical treatment of primary gynecomastia in children and adolescents. In: Townsend CM, Beuchamp RD, Evers BM, eds. There were no restrictions on the basis of date or language of publication. Ann Plast Surg. Guidelines for Adolescent Health Care. Evidence-based clinical practice guideline: Reduction mammaplasty. 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. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. However, these medications should be reserved for those with no decrease in breast size after 2 years. Computed tomography scan of adrenal glands to identify adrenal lesions. Subjects were compared to age-matched norms from another study cohort. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. However, it is unclear if there is any evidence to support this practice. 2015;(10):CD007258. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Ann Plast Surg. padding-right: 18px; Sugrue CM, McInerney N, Joyce CW, et al. Gland Surg. Hoyos AE, Perez ME, Dominguez-Millan R, et al. 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? Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review 1993;91(7):1270-1276. Burdette TE, Kerrigan CL, Homa KA. 1999;103(6):1687-1690. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Gynecomastia: A systematic review. Administration of Benefits and Transition Responsibilities margin-bottom: 38px; All studies on the subject were evaluated for inclusion and 6 studies were included in the review. --> 2012;69(5):510-515. 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. 2002;33:208-217. 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. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. Gynecomastia may be drug-induced. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Saunders Co.; 1991. Schnur PL, Schnur DP, Petty PM, et al. Reduction mammoplasty: Cosmetic or reconstructive procedure? Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. } }. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. color: red Araco A, Gravante G, Araco F, et al. Lonie S, Sachs R, Shen A, et al. Glatt BS, Sarwer DB, O'Hara DE, et al. #backTop:hover { Study subjects included 3538 patients with an average age of 43 years and body mass index of 31.6 kg/m(2) and most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes.The incidence of overall surgical complications was 5.1% and the incidence of major surgical complications was 2.1%. Plastic surgery for teenagers briefing paper. Plast Reconstr Surg. And if you are in Canada the surgeon decides. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. 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. There were 18 out of 415 studies eligible to review. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Ann Plast Surg. 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 . 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. Tang CL, Brown MH, Levine R, et al. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Fagerlund A, Lewin R, Rufolo G, et al. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. 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. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. To get insurance coverage, you'll probably need . Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. border-width:0; /* aetna.com standards styles for templates */ ASPS clinical practice guideline summary on reduction mammaplasty. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Plast Reconstr Surg. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Plast Reconstr Surg. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) When seeking preauthorization for a breast reduction, your goal is generally twofold. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Br J Plast Surg. } The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. 18th ed. Plast Reconstr Surg. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. 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). Reduction mammoplasty for macromastia. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Surgical treatment is indicated when medical treatments fail. The study subjects were stratified into groups based on ages of <60 years and 60 years. Determinants of surgical site infection after breast surgery. 2nd ed. Obstet Gynecol Clin North Am. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. 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. color: blue 1996;20(5):391-397. 2 . Sood R, Mount DL, Coleman JJ 3rd, et al. Current concepts in gynaecomastia. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Socioeconomic Committee Position Paper. Ann Plast Surg. } 1999;103(6):1682-1686. 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. ul.ur li{ Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Mayo Clin Proc. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Arch Dis Child. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Laituri CA, Garey CL, Ostlie DJ, et al. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. #backTop { Analysis was on an intention-to-treat basis. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Karamanos et al (2015) identified their study as the largest sample on breast reduction in the literature, in which age and surgeon specialty did not correlate with negative results. 2000;106(2):280-288. Long-term functional results after reduction mammoplasty. background-color: #663399; Surgery. Prostate Cancer Prostatic Dis. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. There were only 2 studies of a total 25 patients that were considered as good in quality. Aesthet Surg J. Gynecomastia is a very common concern of male adolescence. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Reduction mammoplasty for asymptomatic members is considered cosmetic. A population-level analysis of bilateral breast reduction: does age affect early complications? If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. Ann Plast Surg. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. 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. } This may lead to additional scarring and additional operating time. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. In a systematic review, these investigators examined the role of radiotherapy in this context. A total of 244 out of 1,628 patients with the average age of 23.13 years. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Kerrigan CL, Collins ED, Kneeland TS, et al. .strikeThrough { Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. 2009;19(3):e85-e90. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 2014a;34(3):409-416. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Reduction mammoplasty: Criteria for insurance coverage. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. .headerBar { Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Well-designed clinical trials provide reliable information about the effectiveness of an intervention, and provide valid information about the characteristics of patients who would benefit from that intervention. 2015;75(4):370-375. A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. display: none; The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. 2019;8(4):431-440. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Ages ranged from 18 to 66 years. 2015;75(4):383-387. Can objective predictors for operative success be identified? list-style-type: decimal; Gynecomastia in patients with prostate cancer: A systematic review. Leclere FM, Spies M, Gohritz A, Vogt PM. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). Risk of bias was assessed independently by 2review authors. Breast reduction outcome study. 1994;21(3):539-543. 2000;106(5):991-997. Handschin AE, Bietry D, Hsler R, et al. 2007;356(5):479-485. padding: 10px; Please check your insurance policy to see whether breast reduction is a covered procedure. Pediatr Surg Int. 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. GP Notebook. Principles of breast re-reduction: A reappraisal. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Asian J Surg. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Three review authors undertook independent screening of the search results. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. } Prasetyono TOH, Budhipramono AG, Andromeda I, et al. 2021;147(5):1072-1083. Blomqvist L, Eriksson A, Brandberg Y. 1995;95(1):77-83. Plastic Reconstruct Surg. 2012;130(4):785-789. A total of 15 articles met the inclusion criteria for review. 1969;44(235):291-303. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. .strikeThrough { 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 mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. The Breast: Comprehensive Management of Benign and Malignant Diseases. Brown DM, Young VL. 2013;71(5):471-475. 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. There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. 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. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Breast reduction for symptomatic macromastia. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Townsend: Sabiston Textbook of Surgery. Plastic Reconstr Surg. Plast Reconstr Surg. } Statistical analysis was performed with student t-test and chi-square test. 1998;49:215-234. 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. 2004;113(1):436-437. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Schnur et al (1991) reported on a sliding scale assigns a weight of breast tissue to be removed based on body weight and surface area. 2021 Aug 11 [Online ahead of print]. height:2px; 2001;108(1):62-67. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). These investigators searched the literature on the treatment of Simon's grade I and II gynecomastia in PubMed, Scopus, Science Direct, and Cochrane using keywords "gynecomastia" and "liposuction". Plast Reconstr Surg. #closethis { The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. 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. The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002).