# font-weight: bold; background-color: #663399; Surgery. 2002;109(5):1556-1566. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Annu Rev Med. Management of gestational gigantomastia. font-size: 18px; text-decoration: line-through; Reduction mammaplasty: An outcome study. ul.ur li{ Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Kasielska-Trojan A, Danilewicz M, Antoszewski B. The risks included infection, wound breakdown, scarring, and the need for re-operating. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). Fagerlund A, Lewin R, Rufolo G, et al. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Obesity and complications in breast reduction surgery: Are restrictions justified? 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 In the case of breast reduction, however, for insurance purposes, it . A total of 15 articles met the inclusion criteria for review. Plast Reconstr Surg. He Q, Zheng L, Zhuang D, et al. Med Decis Making. Plast Reconstr Surg. 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). 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. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. 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). 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. cursor: pointer; 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. A cohort study of breast cancer risk in breast reduction patients. list-style-type: decimal; Anesthesia may be injected along with saline solution until the tissue is firm, and a suction cannula is used to extract fat from the breast. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. A total of 244 out of 1,628 patients with the average age of 23.13 years. 1997;185(6):593-603. Last Review01/04/2023. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Tang CL, Brown MH, Levine R, et al. A systematic search of the published literature was performed. Plast Reconstr Surg. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. /* aetna.com standards styles for templates */ 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. This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. No author listed. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. These preliminary findings need to be validated by well-designed studies. Obstet Gynecol Clin North Am. Kerrigan CL, Collins ED, Kneeland TS, et al. 2002;33:208-217. Ann Plastic Surg. American Society of Plastic Surgeons (ASPS). 2018;24(6):1043-1045. Level of Evidence = IV. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review 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:. Many men with breast enlargement are found to have pseudo-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. #backTop { Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. 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. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Plastic Reconstr Surg. Principles of breast re-reduction: A reappraisal. 1999;103(6):1674-1681. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. The Breast: Comprehensive Management of Benign and Malignant Diseases. Plast Reconstr Surg. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. 1993;17(3):211-223. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. padding-right: 18px; 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). Aesthet Surg J. } Ann Plast Surg. 2008;121(4):1092-1100. Plast Reconstr Surg. If an insufficient amount of breast tissue is removed, the surgery is less likely to be successful in relieving pain and any related symptoms from excessive breast weight (e.g., excoriations, rash). Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Endocrinol Metab Clin North Am. The Mammotome procedure represented another novel therapeutic option for gynecomastia. 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. 2005;55(3):227-231. Ann Plast Surg. 1995;95(6):1029-1032. A population-level analysis of bilateral breast reduction: does age affect early complications? 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. 2005;58(3):286-289. 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 . Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. margin-bottom: 38px; When seeking preauthorization for a breast reduction, your goal is generally twofold. 18th ed. To get insurance coverage, you'll probably need . Abnormal histopathological findings were more frequent in patients with reduction mammoplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). 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. 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. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Sugrue CM, McInerney N, Joyce CW, et al. } In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 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. This Clinical Policy Bulletin may be updated and therefore is subject to change. Plast Reconstr Surg. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. } The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). 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. Schnur PL, Schnur DP, Petty PM, et al. Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). Special Clinical Concerns. 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. 2000;106(5):991-997. Follow-up ranged from 2 months to 3 years. For individuals who received radiation treatment to the chest . Breast J. Kerrigan CL, Collins ED, Kim HM, et al. list-style-type: decimal; /*margin-bottom: 43px;*/ Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. (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. 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. outline: none; In these cases, breast reduction for men may take 2 to 3 hours. Gynecomastia may be drug-induced. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Plast Reconstr Surg. Reduction mammoplasty for asymptomatic members is considered cosmetic. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. 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. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). GP Notebook. The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. list-style-type : square !important; right: 30px; Determinants of surgical site infection after breast surgery. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. 2015;49(6):363-366. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; 1998;26(1):61-65. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Plast Reconstr Surg. 2000;106(2):280-288. Often times, insurance company will dictate how much breast tissue to be removed. Reduction mammaplasty. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). Plastic Reconstruct Surg. }. For many patients the psychological impact of the disease is substantial. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia. Wound drainage after plastic and reconstructive surgery of the breast. Quality of life after breast reduction. 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). Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. J Am Coll Surg. 2008;61(5):493-502. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. 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.
aetna breast reduction requirements
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