A detailed physical examination, including testicular examination. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Ann Plastic Surg. 1998;49:215-234. Policy Statement 6d: Aesthetic surgery procedures. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Aesthet Surg J. Ann Plast 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. The health burden of breast hypertrophy. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. list-style-type: upper-alpha; bottom: 20px; Scand J Plast Reconstr Hand Surg. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. 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. Townsend: Sabiston Textbook of Surgery. Reduction mammoplasty for macromastia. Emiroglu M, Salimoglu S, Karaali C, et al. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 2 . Burns JL, Blackwell SJ. Arlington Heights, IL: ASPS; May 2011. 2006;118(4):840-848. A total of 244 out of 1,628 patients with the average age of 23.13 years. Nguyen JT, Wheatley MJ, Schnur PL, et al. 1. 2000;106(2):280-288. Reduction mammoplasty: Criteria for insurance coverage. Plast Reconstr Surg. Gonzalez FG, Walton RL, Shafer B, et al. 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. li.bullet { Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. 2009;7(2):114-119. 2009;19(3):e85-e90. 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). Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). 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 Plast Surg. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Mistry RM, MacLennan SE, Hall-Findlay EJ. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. 2021 Aug 11 [Online ahead of print]. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. } Refer to the member's specific plan document for applicable coverage. 1993;17(3):211-223. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. 2009;62(2):195-199. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. A study by Bruhlmann and Tschopp (1998) was a retrospective study of 246 patients from a surgical practice, approximately 50 % (132) of whom returned a questionnaire about their symptoms and satisfaction with aesthetic results, and their recollection of symptoms prior to surgery. Ages ranged from 18 to 66 years. 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. Breast Reduction | American Society of Plastic Surgeons Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. 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. The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). Reduction mammoplasty improves symptoms of macromastia. 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. 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. Gynecomastia has been classified into2 types. For medical cursor: pointer; ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). And if you are in Canada the surgeon decides. color: white; Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. 2015;10(8):e0136094. 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). Socioeconomic Committee Position Paper. 1995;95(6):1029-1032. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. 2008;32(1):38-44. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Aesthetic Plast Surg. .newText { 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. 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. list-style-type: lower-roman; .newText { In: Townsend CM, Beuchamp RD, Evers BM, eds. 2nd ed. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). color: blue!important; Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Plastic surgery for teenagers briefing paper. PDF 0185 Breast Reconstructive Surgery (1) - Aetna Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. .arrowPurpleSmall, a:hover.arrowPurpleSmall { Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Horm Res Paediatr. PDF Summary of Proposed Aetna Medicare Advantage Agreement Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor 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. Collins ED, Kerrigan CL, Kim M, et al. When seeking preauthorization for a breast reduction, your goal is generally twofold. 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. ul.ur li{ In other patients, excess skin and nipple and areola relocation are necessary. Aesthetic Plast Surg. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. 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. Li CC, Fu JP, Chang SC, et al. Current concepts in gynaecomastia. 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. The study subjects were stratified into groups based on ages of <60 years and 60 years. With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an out-patient; however, this was not statistically significant (p = 0.07). list-style-type: decimal; Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? width: 100%; 2000;106(5):991-997. and areola. 2016;20(3):256-260. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Washington, DC: ACOG; 2011:121-122. Special Clinical Concerns. Plast Reconstr Surg. Prostate Cancer Prostatic Dis. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. 2013;71(5):471-475. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Plast Reconstr Surg. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Women's Health and Cancer Rights Act of 1998. Surgical treatment of gynecomastia: Complications and outcomes. Reduction mammaplasty: Defining medical necessity. Breast asymmetries: A brief review and our experience. 2012;130(4):785-789. Breast reduction surgery - Mayo Clinic 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. Am Surg. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Arch Dis Child. 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". } 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. This may lead to additional scarring and additional operating time. J Pediatr Surg. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Measuring health state preferences in women with breast hypertrophy. 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. Risk of bias was assessed independently by 2review authors. The author concluded that the current level of evidence on this subject was very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. 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. The end-point was the complete resolution of gynecomastia. 1999;103(6):1687-1690. 2014a;34(1):66-73. } Breast hypertrophy. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. 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. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Plast Reconstr Surg. } Saunders Co.; 1991. 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. Ann Plast Surg. 2007;119(4):1159-1166. Sood R, Mount DL, Coleman JJ 3rd, et al. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna All the patients recovered well and were satisfied with the cosmetic outcomes. 1995;34(2):113-116. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. Wound drainage after plastic and reconstructive surgery of the breast. Priorities Forum Policy Statement. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna 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.
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