Chadbourne EB, Zhang S, Gordon MJ, et al. background-position: right 65%; The primary outcome was the difference in wound drainage over 24 hours. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. The Breast: Comprehensive Management of Benign and Malignant Diseases. Risk factors for complications following breast reduction: Results from a randomized control trial. 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. border-radius: 4px; 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. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. 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. 2018;89(6):408-412. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. 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. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. Gynecomastia has been classified into2 types. Subjects were compared to age-matched norms from another study cohort. 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). Ann Plast Surg. Plast Reconstr Surg. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Variations in pattern of pubertal changes in girls. right: 30px; Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. 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. Often times, insurance company will dictate how much breast tissue to be removed. 2005;58(3):286-289. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Hoyos AE, Perez ME, Dominguez-Millan R, et al. Arlington Heights, IL: ASPRS; 1987. 2021 Aug 11 [Online ahead of print]. Kerrigan CL, Collins ED, Kim HM, et al. 1994;21(3):539-543. A cohort study of breast cancer risk in breast reduction patients. 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. 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. Aesthet Surg J. They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Horm Res Paediatr. Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. The mean age was 42.8 years (SD 19.5 years). padding-right: 18px; Ann Chir Plast Esthet. Fagerlund A, Cormio L, Palangi L, et al. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. OL OL LI { Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) } A total of 244 out of 1,628 patients with the average age of 23.13 years. 2008;121(4):1092-1100. hr.separator { } 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. ol.numberedList LI { 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 Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. 2009;7(2):114-119. Laituri CA, Garey CL, Ostlie DJ, et al. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. color: red!important; 2007;356(5):479-485. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Leclere FM, Spies M, Gohritz A, Vogt PM. 2007;119(4):1159-1166. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. 01/04/2023 .headerBar { Reduction mammoplasty: Criteria for insurance coverage. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. of the following criteria must be met: This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Gland Surg. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline American Society of Plastic and Reconstructive Surgery (ASPRS). 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. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. #backTop { Collis N, McGuiness CM, Batchelor AG. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. list-style-type: decimal; No data were provided on loss to follow-up. 2016;20(3):256-260. list-style-type: lower-roman; 40 . 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. 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. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Another set of breast pump supplies if you get pregnant . Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. cursor: pointer; Schnur PL, Hoehn JG, Ilstrup DM, et al. Plast Reconstr Surg. 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. Reduction mammaplasty: The need for prospective randomized studies. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Howrigan P. Reduction and augmentation mammoplasty. What can I do if my insurance denies coverage for breast reduction? Priorities Forum Policy Statement. breast augmentation with implant. 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. skin should not be excised horizontally below the inframammary fold. J Am Coll Surg. Grooving where the bra straps sit on the shoulder. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Endocrinol Metab Clin North Am. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. J Pediatr Surg. There were only 2 studies of a total 25 patients that were considered as good in quality. # font-weight: bold; World J Surg. 1997;100(4):875-883. 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. 2015;49(6):363-366. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Arch Dis Child. font-size: 18px; Plastic Reconstruct Surg. } Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. --> Ann Plast Surg. Ann Plast Surg. 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. Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. 1998;101(2):361-364. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Asian J Surg. 2015;10(8):e0136094. list-style-type : square !important; list-style-type: lower-alpha; 2020 Sep 4 [Online ahead of print]. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. How to Get Your Breast Reduction Covered By Insurance - RealSelf News The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. #closethis { Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . GP Notebook. 2019;8(4):431-440. Blomqvist L, Eriksson A, Brandberg Y. 2008;53(3):255-261. 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 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). Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Breast hypertrophy. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. 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. } Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Administration of Benefits and Transition Responsibilities } 2010;45(3):650-654. bottom: 20px; The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. 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. Surgical treatment of gynecomastia: Complications and outcomes. Saunders Co.; 1991. Analysis was on an intention-to-treat basis. Socioeconomic Committee Position Paper. These preliminary findings need to be validated by well-designed studies. Breast J. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. 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. Fagerlund A, Lewin R, Rufolo G, et al. 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). Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. 2 . 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. Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). Plast Reconstr Surg. Breast reduction for symptomatic macromastia. } Fischer S, Hirsch T, Hirche C, et al. 2003;111(2):688-694. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. background-color: #663399; } 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. Please check your insurance policy to see whether breast reduction is a covered procedure. 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. 2001;76(5):503-510. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? See Appendix for Table 1. list-style-type: upper-alpha; color: blue Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Brown DM, Young VL. 1995;95(1):77-83. The average age was 24.7 years (range of 18 to 47 years). 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. Breast reduction surgery - Mayo Clinic 1999;103(6):1682-1686. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . A physician-supervised diet and exercise plan may be indicated in obese patients. 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. Level of Evidence = IV. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Cochrane Database Syst Rev. Breast asymmetries: A brief review and our experience. Collins ED, Kerrigan CL, Kim M, et al. Management of gestational gigantomastia. Pediatr Surg Int. 2001;108(1):62-67. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. of . Kasielska-Trojan A, Danilewicz M, Antoszewski B. } Coding Mental health care professionals may be consulted to address psychological distress from gynecomastia. 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. PDF Procedures, programs and drugs you must precertify - AmeriBen 1995;95(6):1029-1032.
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