aetna breast reduction requirements

Posted on March 14, 2023 by

The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. } 1999;103(6):1674-1681. /*margin-bottom: 43px;*/ Collins ED, Kerrigan CL, Kim M, et al. 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. 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%. 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. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. 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. 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: background-position: right 65%; 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. 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. Bertin ML, Crowe J, Gordon SM. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Mizgala CL, MacKenzie KM. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. 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. color: red!important; 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). Three review authors undertook independent screening of the search results. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. 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. 2014b;48(5):334-339. 2021;74(11):3128-3140. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. Other just require 500 grams no matter what your height and weight. 2015;75(4):383-387. 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. Risk factors for complications following breast reduction: Results from a randomized control trial. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. 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. 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. A systematic search of the published literature was performed. } z-index: 99; 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.. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. 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. 2012;130(4):785-789. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Endocrinol Metab Clin North Am. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years). 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. Socioeconomic Committee Position Paper. Khan SM, Smeulders MJ, Van der Horst CM. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Breast and aesthetic surgery. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Fagerlund A, Lewin R, Rufolo G, et al. The majority (87.7 %) of cases presented with accompanying mastalgia. Plastic Reconstruct Surg. 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. li.bullet { color: red 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). 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. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 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:. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. Plast Reconstr Surg. 1997;185(6):593-603. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. 2006;30(3):309-319. 18th ed. 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. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Ann Plast Surg. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. 2015;10(8):e0136094. Plast Reconstr 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. For many patients the psychological impact of the disease is substantial. Plast Reconstr Surg. Plast Reconstr Surg. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. 2003;111(2):688-694. } The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Also, there was no correlation between PR expression and 2D: 4D. Oxfordshire NHS Trust. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). 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). Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Treating providers are solely responsible for medical advice and treatment of members. Please check your insurance policy to see whether breast reduction is a covered procedure. 2012;69(5):510-515. Laituri CA, Garey CL, Ostlie DJ, et al. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. 1998;26(1):61-65. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. 2018;89(6):408-412. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. 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. Arlington Heights, IL: ASPS; March 9, 2002. Miller AP, Zacher JB, Berggren RB, et al. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). Ann Chir Plast Esthet. Surgical treatment is indicated when medical treatments fail. OL OL LI { 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. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. Gland Surg. Plast Reconstr Surg. This Clinical Policy Bulletin may be updated and therefore is subject to change. color: blue!important; High-risk lesions (atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], and lobular carcinoma in situ [LCIS]) were revealed in 37 (11.7 %), and cancer in 6 (1.9 %) patients. 2006;118(4):840-848. The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. Last Review01/04/2023. 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. Plast Reconstr Surg. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. The mean age was 42.8 years (SD 19.5 years). Tang CL, Brown MH, Levine R, et al. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. 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). The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. 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. /* aetna.com standards styles for templates */ ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Priorities Forum Policy Statement. 2 . I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. J Am Coll Surg. Surgeon. 2021 Aug 11 [Online ahead of print]. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 1999;103(1):76-82; discussion 83-85. .strikeThrough { The primary outcome was the difference in wound drainage over 24 hours. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. hr.separator { The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. 40 . Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). 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. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients.

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aetna breast reduction requirements