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. Also, there was no correlation between PR expression and 2D: 4D. 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. Gynecomastia in patients with prostate cancer: A systematic review. 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. A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. 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). Plast Reconstr Surg. 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. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. 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). #backTop:hover { Wound drainage after plastic and reconstructive surgery of the breast. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. 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). Recommended criteria for insurance coverage of reduction mammoplasty. In a systematic review, these investigators examined the role of radiotherapy in this context. J Am Coll Surg. Guidelines for Adolescent Health Care. 2018;7(Suppl 1):S70-S76. Coding Aesthetic Plast Surg. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; margin-bottom: 38px; Glatt BS, Sarwer DB, O'Hara DE, et al. Breast reduction for symptomatic macromastia. 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. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Plastic Reconstr Surg. Plast Reconstr Surg. Plast Reconstr Surg. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Women's Health and Cancer Rights Act of 1998. 2010;125(5):1301-1308. 2009;19(3):e85-e90. Plastic Reconstruct Surg. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. 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. Plast Reconstr Surg. Ann Plast Surg. 1993;17(3):211-223. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. 2008;61(5):493-502. 2006;30(3):309-319. border-radius: 4px; Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne } A total of 90 patients underwent breast re-reduction surgery. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Gynecomastia. background-color: #cc0066; If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. The risks included infection, wound breakdown, scarring, and the need for re-operating. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Obesity and complications in breast reduction surgery: Are restrictions justified? The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Many men with breast enlargement are found to have pseudo-gynecomastia. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. J Plast Reconstr Aesthet Surg. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Ann Plast Surg. Horm Res Paediatr. 2 . In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Thus, more than 1/3of operative subjects selected for inclusion in the study did not complete it; most of the operative subjects who did not complete the study were lost to follow-up. Reduction mammaplasty: An outcome study. Prepubertal gynecomastia linked to lavender and tea tree oils. Howrigan P. Reduction and augmentation mammoplasty. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Mizgala CL, MacKenzie KM. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Plast Reconstr Surg. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. There were only 2 studies of a total 25 patients that were considered as good in quality. Seitchik MW. 2017;35:157-161. No author listed. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Treating providers are solely responsible for medical advice and treatment of members. Brown DM, Young VL. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. color: red 2009;62(2):195-199. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Reduction mammaplasty. For many patients the psychological impact of the disease is substantial. 2011;128(4):243e-249e. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Links to various non-Aetna sites are provided for your convenience only. A total of 15 articles met the inclusion criteria for review. text-decoration: line-through; 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. 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. Reduction mammoplasty for asymptomatic members is considered cosmetic. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). However, it is unclear if there is any evidence to support this practice. Another set of breast pump supplies if you get pregnant . These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. Arch Dis Child. Ann Chir Plast Esthet. right: 30px; Gonzalez FG, Walton RL, Shafer B, et al. color: white; background-position: right 65%; 2008;53(3):255-261. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Evidence-based clinical practice guideline: Reduction mammaplasty. 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. 2014;20(3):274-278. Three review authors undertook independent screening of the search results. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Gland Surg. 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. Arlington Heights, IL: ASPRS; 1987. Kalliainen LK; ASPS Health Policy Committee. 1999;103(6):1687-1690. 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. This will be computed based on your body area. Last Review01/04/2023. J Plast Surg Hand Surg. 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.. The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. A population-level analysis of bilateral breast reduction: does age affect early complications? Marshall WA, Tanner JM. Breast asymmetries: A brief review and our experience. 2002;33:208-217. The authors stated that operative subjects were told that their responses to the questionnaire were not to be used for insurance and thus the subjects had no motivation to exaggerate symptoms prior to surgery in questionnaire responses; however, it is not clear whether operative subjects would be willing to submit responses to a questionnaire from the doctor that differed substantially from the history that they provided to the doctor during their preoperative evaluation. Breast Concerns of Adolescents. cursor: pointer; Macromastia: all . 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. Med Decis Making. 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. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Rising Rates of Insurance Denial for Breast Reduction Surgery 2005;55(3):227-231. Special Clinical Concerns. Emiroglu M, Salimoglu S, Karaali C, et al. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Fischer JP, Cleveland EC, Shang EK, et al. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. 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. 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. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. .strikeThrough { Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. The health burden of breast hypertrophy. 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. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. 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). An average of 320 specimens were excised from each side with mean blood loss of 34 ml. In addition, Nguyen et al (2004) ignored a wealth of published evidence of the effectiveness of physical therapy, analgesics and other conservative measures on back and neck pain generally. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note Can objective predictors for operative success be identified? The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Plast Reconstr Surg. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. A total of 244 out of 1,628 patients with the average age of 23.13 years. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. 2015;10(8):e0136094. PDF Summary of Proposed Aetna Medicare Advantage Agreement Breast and aesthetic surgery. Townsend: Sabiston Textbook of Surgery. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. 1991;27(3):232-237. Plast Reconstr Surg. OL OL OL OL LI { Tang CL, Brown MH, Levine R, et al. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Plast Reconstr Surg. Treatment of adolescent gynecomastia. 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. Surgical management of gynecomastia--a 10-year analysis. 1998;41(3):240-245. 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 . 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. 2007;119(4):1159-1166. 2021;74(11):3128-3140. Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Variations in pattern of pubertal changes in girls. 2007;356(5):479-485. 2000;106(5):991-997. top: 0px; Arlington Heights, IL: ASPS; March 9, 2002. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Refer to the member's specific plan document for applicable coverage. Level of Evidence = IV. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). PLoS One. Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. J Plast Surg Hand Surg. Does Health Insurance Cover Breast Reduction Surgery? - GoodRx OL OL LI { Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. 1999;103(6):1682-1686. Reduction mammaplasty provides long-term improvement in health status and quality of life. 2001;108(1):62-67. J Pediatr Surg. Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna Surgical treatment is indicated when medical treatments fail. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. and areola. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. The authors concluded that the limited evidence available showed no significant benefit of using post-operative wound drains in reduction mammoplasty, although LOS may be shorter when drains are not used. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. And if you are in Canada the surgeon decides. Socioeconomic Committee Position Paper. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. All patients underwent routine investigations to exclude secondary causes of gynecomastia. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. list-style-type: lower-roman; What can I do if my insurance denies coverage for breast reduction? Gynecomastia is a very common concern of male adolescence. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Second, it is the burden of the proponent of an intervention to provide reliable evidence of its effectiveness, not the burden of ones whoquestion the effectivenessan intervention to provide definitive proof of ineffectiveness. 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. 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. Breast reduction surgery - Mayo Clinic PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. list-style-type: decimal; .newText { OL OL OL LI { Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. 1997;185(6):593-603. Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast. padding: 15px; background: #5e9732; Plast Reconstr Surg. Reduction mammaplasty: Defining medical necessity. 2009;7(2):114-119. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Gynecomastia in patients with prostate cancer: Update on treatment options. Current concepts in gynaecomastia. Ann Plastic Surg. 1993;91(7):1270-1276. 1969;44(235):291-303. 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).