When seeking preauthorization for a breast reduction, your goal is generally twofold. Philadelphia, PA: W.B. You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. list-style-type: decimal; Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. display: block; list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Determinants of surgical site infection after breast surgery. Plastic Reconstr Surg. Another set of breast pump supplies if you get pregnant . Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. (25 y/o female with a 38J bra size) according to aetna, I should more than qualify for a reduction as I have back, neck, shoulder pain, chest pain and pressure, arm numbness while laying on sides, etc. 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. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Gynecomastia may be drug-induced. 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. Araco A, Gravante G, Araco F, et al. 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. Autorino R, Perdona S, D'Armiento M, et al. Arlington Heights, IL: ASPS; March 9, 2002. J Am Coll Surg. For individuals who received radiation treatment to the chest . Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. 01/04/2023 Reduction mammoplasty for asymptomatic members is considered cosmetic. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. } Surg Laparosc Endosc Percutan Tech. Plast Reconstr Surg. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. This Clinical Policy Bulletin may be updated and therefore is subject to change. 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 mammaplasty provides long-term improvement in health status and quality of life. 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., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). J Plast Surg Hand Surg. 1999;103(1):76-82; discussion 83-85. of . 2021;147(5):1072-1083. Narula HS, Carlson HE. 2018;89(6):408-412. Emiroglu M, Salimoglu S, Karaali C, et al. Collins ED, Kerrigan CL, Kim M, et al. breast augmentation with implant. 2009;7(2):114-119. Flancbaum L, Choban PS. 2021;74(11):3128-3140. 1995;95(6):1029-1032. 2 . Mental health care professionals may be consulted to address psychological distress from gynecomastia. 2008;53(3):255-261. 2017;35:157-161. Gynecomastia. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. #closethis { Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. Hello! 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. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. } This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). 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. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. 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:. Plast Reconstr Surg. text-decoration: line-through; Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Surgical treatment of primary gynecomastia in children and adolescents. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). 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. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. 2018;7(Suppl 1):S70-S76. 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. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Risk of bias was assessed independently by 2review authors. Bertin ML, Crowe J, Gordon SM. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. No author listed. Breast and aesthetic surgery. 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. Brown DM, Young VL. Nguyen JT, Wheatley MJ, Schnur PL, et al. 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. Plast Reconstr Surg. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. cursor: pointer; Surgical management of gynecomastia--a 10-year analysis. Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). Kalliainen LK; ASPS Health Policy Committee. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Reduction mammaplasty: The need for prospective randomized studies. 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. Petty PM, Solomon M, Buchel EW, Tran NV. Handschin AE, Bietry D, Hsler R, et al. list-style-type: lower-alpha; Statistical analysis was performed with student t-test and chi-square test. .strikeThrough { Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Variations in pattern of pubertal changes in girls. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). The authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). 2015;(10):CD007258. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Furthermore, the lack of an expected "dose-response" relationship between the amount of breast tissue removed and the magnitude of symptomatic relief in these studies raises questions about the validity of these studies and the effectiveness of breast reduction as a method of relieving shoulder and back pain. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . text-decoration: underline; Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 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. 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. American Society of Plastic and Reconstructive Surgery (ASPRS). Schnur PL, Schnur DP, Petty PM, et al. Ann Plast Surg. Guidelines for Adolescent Health Care. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. 2001;108(6):1591-1599. 1998;101(2):361-364. 2015;49(6):311-318. } Setala L, Papp A, Joukainen S, et al. 2010;125(5):1301-1308. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 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. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. 2018;24(6):1043-1045. J Plast Reconstr Aesthet Surg. OL LI { 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 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". The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. height:2px; Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Plastic Reconstruct Surg. The average age was 24.7 years (range of 18 to 47 years). Sugrue CM, McInerney N, Joyce CW, et al. 2001;108(1):62-67. 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. In the case of breast reduction, however, for insurance purposes, it . Reduction mammaplasty: An outcome study. Arlington Heights, IL: ASPS; May 2011. Surgical treatment of gynecomastia: Complications and outcomes. 2014a;34(3):409-416. 1995;34(2):113-116. Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. 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. A cohort study of breast cancer risk in breast reduction patients. color: red Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Principles of breast re-reduction: A reappraisal. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 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. Aesthetic Plast Surg. Aesthetic Plast Surg. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Glatt BS, Sarwer DB, O'Hara DE, et al. color: red!important; ASPS clinical practice guideline summary on reduction mammaplasty. Surgical treatment is indicated when medical treatments fail. You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. 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. } Patient demographics, surgical technique, and outcomes were analyzed. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. A total of 244 out of 1,628 patients with the average age of 23.13 years. In a systematic review, these investigators examined the role of radiotherapy in this context. Scand J Plast Reconstr Hand Surg. 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 Kerrigan CL, Collins ED, Striplin D, et al. This may lead to additional scarring and additional operating time. Women's Health and Cancer Rights Act of 1998. position: fixed; 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). Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Gynecomastia: A systematic review. Cochrane Database Syst Rev. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Level of Evidence = IV. Disproportionately large breasts can cause both physical and emotional . A follow-up study of 105 women with breast cancer following reduction mammaplasty. Also, there was no correlation between PR expression and 2D: 4D. 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. } Plast Reconstr Surg. of the following criteria must be met: Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Links to various non-Aetna sites are provided for your convenience only. 2012;130(4):785-789. 1999;103(6):1687-1690. Obesity and complications in breast reduction surgery: Are restrictions justified? 2000;106(5):991-997. 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. 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. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. A total of 90 patients underwent breast re-reduction surgery. 1. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up.
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