aetna breast reduction requirements

Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Quality of life after breast reduction. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Washington, DC: ACOG; 2011:121-122. padding-bottom: 4px; Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. 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. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. 1999;103(6):1682-1686. breast augmentation with implant. ol.numberedList LI { Surgery. J Plast Reconstr Aesthet Surg. 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]). Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Plast Reconstr Surg. Level of Evidence = IV. A total of 90 patients underwent breast re-reduction surgery. 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 of the following criteria must be met: Tang CL, Brown MH, Levine R, et al. Aesthetic Plast Surg. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. A total of 81 patients were included in this study. 2015;49(6):311-318. Raispis T, Zehring RD, Downey DL. Breast cancer found at the time of breast reduction. Araco A, Gravante G, Araco F, et al. 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. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. 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. Breast hypertrophy. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. 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. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? 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. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. A detailed physical examination, including testicular examination. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Plast Reconstr Surg. Ann Plast Surg. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Arlington Heights, IL: ASPS; May 2011. Long-term functional results after reduction mammoplasty. Policy Statement 6d: Aesthetic surgery procedures. Links to various non-Aetna sites are provided for your convenience only. 2012;130(4):785-789. .fixedHeaderWrap { From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Ann Chir Plast Esthet. J Plast Surg Hand Surg. 2008;53(3):255-261. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). color: white; A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. 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). I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. 2002;109(5):1556-1566. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 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. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Arch Dis Child. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. margin-bottom: 38px; 2 . Plast Reconstr Surg. li.bullet { Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. 2017;139(6):1313-1322. American Society of Plastic Surgeons (ASPS). 2014b;48(5):334-339. list-style-type: lower-alpha; Gynecomastia: Evolving paradigm of management and comparison of techniques. 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. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Lonie S, Sachs R, Shen A, et al. Resolution of idiopathic gynecomastia may take several months to years. Asian J Surg. Plast Reconstr Surg. 2001;107(5):1234-1240. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Gonzalez FG, Walton RL, Shafer B, et al. background-color: #cc0066; 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. The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. } 2007;119(4):1159-1166. 2020 Sep 4 [Online ahead of print]. 2011;128(4):243e-249e. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. J Pediatr Surg. Annu Rev Med. The mean age was 42.8 years (SD 19.5 years). (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) 2015;(10):CD007258. Arlington Heights, IL: ASPS; March 9, 2002. Reduction mammaplasty: A review of managed care medical policy coverage criteria. 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. A physician-supervised diet and exercise plan may be indicated in obese patients. Flancbaum L, Choban PS. Reduction mammoplasty: Criteria for insurance coverage. 2015;49(6):363-366. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. font-size: 18px; Med Decis Making. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. Note: Chronic intertrigo, eczema, dermatitis, and/or ulceration in the infra-mammary fold in and of themselves are not considered medically necessary indications for reduction mammoplasty. 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). 2016;20(3):256-260. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. } text-decoration: underline; Ann Plastic Surg. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Endocrinol Metab Clin North Am. This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Surgical implications of obesity. .headerBar { Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Can objective predictors for operative success be identified? 2021;74(11):3128-3140. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Plast Reconstr Surg. Aetna considers breast reconstructive surgery to correct The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. color: red