aetna breast reduction requirements

1993;17(3):211-223. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. 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. For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Plast Reconstr Surg. /*margin-bottom: 43px;*/ } Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Emiroglu M, Salimoglu S, Karaali C, et al. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Chadbourne EB, Zhang S, Gordon MJ, et al. 2008;61(5):493-502. 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). The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. The authors (Nguyen et al, 2004) argue, based primarily on the results of the ASPS-funded BRAVO study (described below), that (with a single exception) no objective criteria for breast reduction surgery are supportable, including criteria based upon the presence of particular signs or symptoms, requirements based upon breast size or the amount of breast tissue removed, any minimum age limitations, any limitation based upon maximum body weight, requirements for a trial of conservative therapy, or the exclusion of certain procedures (liposuction). of the following criteria must be met: Recommended criteria for insurance coverage of reduction mammoplasty. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Handschin AE, Bietry D, Hsler R, et al. 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. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Petty PM, Solomon M, Buchel EW, Tran NV. 2001;76(5):503-510. background: #5e9732; 2014b;48(5):334-339. Subjects were compared to age-matched norms from another study cohort. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Oxfordshire NHS Trust. Plast Reconstr Surg. ul.ur li{ Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Reduction mammaplasty provides long-term improvement in health status and quality of life. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Gynecomastia. } J Plast Surg Hand Surg. background-color: #663399; For many patients the psychological impact of the disease is substantial. color: blue In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Aesthet Surg J. Obesity and complications in breast reduction surgery: Are restrictions justified? The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. J Laparoendosc Adv Surg Tech A. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. A physician-supervised diet and exercise plan may be indicated in obese patients. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. 2014;20(3):274-278. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. 2020 Sep 4 [Online ahead of print]. Am J Infect Control. 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. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. color: red!important; list-style-type: decimal; Pediatr Surg Int. Exposure to partners using estrogen containing vaginal creams; Cancer chemotherapy (alkylating agents, methotrexate, vinca alkaloids, imatinib, combination chemotherapy), Androgen receptor blockers - bicalutamide, 5 reductase inhibitors - finasteride, dutasteride, Angiotensin converting enzyme inhibitors (captopril, enalapril), Calcium channelblockers(diltiazem, nifedipine, verapamil), Anabolic steroids(e.g., in body builders). 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. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. color: blue!important; 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. Breast J. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. font-size: 18px; } 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. The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. For medical A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. 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). 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. Tang CL, Brown MH, Levine R, et al. of . Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. 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). Resolution of idiopathic gynecomastia may take several months to years. 1998;41(3):240-245. Oxford, UK: National Health Service (NHS); October 2008. 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. Scand J Plast Reconstr Hand Surg. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). 2015;(10):CD007258. Plast Reconstr Surg. Plast Reconstr Surg. 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. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. All patients underwent routine investigations to exclude secondary causes of gynecomastia. 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. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. 1991;27(3):232-237. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Surgical treatment of gynecomastia: Complications and outcomes. # font-weight: bold; Can objective predictors for operative success be identified? Prepubertal gynecomastia linked to lavender and tea tree oils. 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. Reduction mammoplasty for asymptomatic members is considered cosmetic. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. padding-right: 18px; Cochrane Database Syst Rev. list-style-type : square !important; 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? While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Long-term functional results after reduction mammoplasty. Level of Evidence = IV. Ann Plast Surg. 2006;118(4):840-848. Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). 2015;75(4):383-387. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Breast cancer found at the time of breast reduction. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. The Breast: Comprehensive Management of Benign and Malignant Diseases. 2009;19(3):e85-e90. Plastic Reconstr Surg. Ann Chir Plast Esthet. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. A total of 81 patients were included in this study. 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. border: none; Many men with breast enlargement are found to have pseudo-gynecomastia. 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). These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Brown MH, Weinberg M, Chong N, et al. padding: 10px; Autorino R, Perdona S, D'Armiento M, et al. 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. } 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. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. } ASPS Recommended Coverage Criteria for Third Party Payors. Reduction mammoplasty for macromastia. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. ol.numberedList LI { Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; American Society of Plastic Surgeons (ASPS). Kerrigan CL, Collins ED, Kim HM, et al. 1. Gynecomastia has been classified into2 types. Schnur PL, Schnur DP, Petty PM, et al. 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. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. 2006;30(3):309-319. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Priorities Forum Policy Statement. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Risk of bias was assessed independently by 2review authors. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. 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. Macromastia: all . Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. 2002;109(5):1556-1566. World J Surg. The health burden of breast hypertrophy. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. Guidelines for Adolescent Health Care. Fagerlund A, Cormio L, Palangi L, et al. Fischer S, Hirsch T, Hirche C, et al. Plast Reconstr Surg. 2005;55(3):227-231. } Burdette TE, Kerrigan CL, Homa KA. Determinants of surgical site infection after breast surgery. Plast Reconstr Surg. border-radius: 4px; 1994;21(3):539-543. Asian J Surg. 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). Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. J Plast Surg Hand Surg. 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. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. 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. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). 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:. 2000;106(2):280-288. Surgery. Breast reduction outcome study. Bertin ML, Crowe J, Gordon SM. 1995;34(2):113-116. 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. } 2017;35:157-161. Reduction mammoplasty improves symptoms of macromastia. outline: none; Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Treating providers are solely responsible for medical advice and treatment of members. 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. Arlington Heights, IL: ASPRS; 1987. 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. Ann Plastic Surg. Bland KI, Copeland EM, eds. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. 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". 2018;89(6):408-412. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. 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. Gynecomastia is a very common concern of male adolescence. Collins ED, Kerrigan CL, Kim M, et al. Wound drainage after plastic and reconstructive surgery of the breast. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Plast Reconstr Surg. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. 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 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 majority (87.7 %) of cases presented with accompanying mastalgia. 2014a;34(3):409-416. Glatt BS, Sarwer DB, O'Hara DE, et al. N Engl J Med. A cohort study of breast cancer risk in breast reduction patients. The mean volume of tissue resected was 250 g (range of 22 to 758 g) from the right breast and 244 g (range of 15 to 705 g) from the left breast. The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. 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. 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). Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne color: red The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Arlington Heights, IL: ASPS; March 9, 2002. Am Surg. #closethis { He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Current concepts in gynaecomastia. 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. Saunders Co.; 1991. Raispis T, Zehring RD, Downey DL. Surgeon. 2006;9(2):109-114. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 2001;108(1):62-67. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. 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. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. border-width:0; The Mammotome procedure represented another novel therapeutic option for gynecomastia.

Technika Gas Cooktop Igniter Problem, Peachtree Hills Court Apartments, Articles A