Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Sood R, Mount DL, Coleman JJ 3rd, et al. No other operation-related complications were observed. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 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. --> The majority (87.7 %) of cases presented with accompanying mastalgia. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. Principles of breast re-reduction: A reappraisal. Magnetic Resonance Imaging (MRI) of the Breast - Aetna Gynecomastia. What can I do if my insurance denies coverage for breast reduction? Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Plast Reconstr Surg. Schnur PL, Hoehn JG, Ilstrup DM, et al. 2009;7(2):114-119. OL OL OL LI { 2017;35:157-161. Ann Plast Surg. color: white; The primary outcome was the difference in wound drainage over 24 hours. Measuring health state preferences in women with breast hypertrophy. 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. Evidence-based clinical practice guideline: Reduction mammaplasty. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. Qu S, Zhang W, Li S, et al. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Arch Dis Child. What are Aetna breast reduction requirements? - RealSelf.com skin should not be excised horizontally below the inframammary fold. Reduction mammaplasty provides long-term improvement in health status and quality of life. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. 1995;95(6):1029-1032. 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. Breast J. 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. Risk factors for complications following breast reduction: Results from a randomized control trial. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. .newText { Aesthetic Plast Surg. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com OL OL LI { Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. OL OL OL OL LI { } 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. Obesity and complications in breast reduction surgery: Are restrictions justified? Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Patient demographics, surgical technique, and outcomes were analyzed. They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. 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. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna Aesthetic Plast Surg. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). } J Plast Surg Hand Surg. 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. A total of 90 patients underwent breast re-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. 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. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. background-position: right 65%; of . Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Prepubertal gynecomastia linked to lavender and tea tree oils. Plast Reconstr 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. color: blue Little is known about the effect of surgical treatment on the psychological aspects of the disease. All patients underwent routine investigations to exclude secondary causes of gynecomastia. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. 2012;130(4):785-789. 2021;147(5):1072-1083. Resolution of idiopathic gynecomastia may take several months to years. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. 2008;32(1):38-44. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. Gynecomastia: A systematic review. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. Breast Concerns of Adolescents. Often times, insurance company will dictate how much breast tissue to be removed. 2019;166(5):934-939. } } Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. 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. For individuals who received radiation treatment to the chest . Tang CL, Brown MH, Levine R, et al. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Handschin AE, Bietry D, Hsler R, et al. 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. Obstet Gynecol Clin North Am. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; 2003;111(2):688-694. In addition, Nguyen et al (2004) ignored a wealth of published evidence of the effectiveness of physical therapy, analgesics and other conservative measures on back and neck pain generally. Raispis T, Zehring RD, Downey DL. Long-term functional results after reduction mammoplasty. Araco A, Gravante G, Araco F, et al. font-size: 18px; All the patients recovered well and were satisfied with the cosmetic outcomes. 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. 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. The study subjects were stratified into groups based on ages of <60 years and 60 years. Chadbourne EB, Zhang S, Gordon MJ, et al. Fischer S, Hirsch T, Hirche C, et al. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. } J Plast Surg Hand Surg. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Breast and aesthetic surgery. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. 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. Schnur et al (1991) reported on a sliding scale assigns a weight of breast tissue to be removed based on body weight and surface area. There were only 2 studies of a total 25 patients that were considered as good in quality. Aesthet Plastic Surg. The end-point was the complete resolution of gynecomastia. color: red!important; 1993;91(7):1270-1276. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 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. Oxford, UK: National Health Service (NHS); October 2008. 2015;10(8):e0136094. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Ann Plast Surg. 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. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. 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). An 18-question survey was created evaluating various aspects of BBR practice; UK and Irish plastic and reconstructive and breast surgeons were invited to participate by an e-mail containing a link to a web-based survey. 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. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction 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". Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Aesthet Surg J. 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. 1991;27(3):232-237. Fischer JP, Cleveland EC, Shang EK, et al. American Society of Plastic and Reconstructive Surgery (ASPRS). PLoS One. The authors reach the remarkable conclusion that a woman with normal sized breasts who has only a few ounces of breast tissue removed is as likely to receive as much benefit from breast reduction surgery as a women with large breasts who has substantially more breast tissue removed. Breast reduction for symptomatic macromastia. .strikeThrough { Reduction mammoplasty: Criteria for insurance coverage. 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. 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. list-style-type: lower-roman; Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. 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). } 2006;9(2):109-114. Management of gestational gigantomastia. Kalliainen LK; ASPS Health Policy Committee. 2002;33:208-217. 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. Arlington Heights, IL: ASPS; 2011. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Horm Res Paediatr. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Kerrigan CL, Collins ED, Kim HM, et al. background-color: #cc0066; Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. The member has gigantomastia of pregnancy accompanied byany of the following complications, and delivery is not imminent: For medical necessity criteria for surgery to correct breast asymmetry, seeCPB 0185 - Breast Reconstructive Surgery. 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. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Priorities Forum Policy Statement. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. 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. Reduction mammoplasty for macromastia. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. PDF Gender Dysphoria Treatment - Cigna 1999;103(6):1687-1690. Reduction mammaplasty: Defining medical necessity. of the following criteria must be met: 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. The condition not only must be unresponsive to dermatological treatments (e.g., antibiotics or antifungal therapy) and conservative measures (e.g., good skin hygiene, adequate nutrition) for a period of 6 months or longer, but also must satisfy criteria stated insection I above. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. 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. Med Decis Making. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. list-style-type: lower-alpha; Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. Major complications (1.6 %) included unilateral hematoma and localized infection. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Surgical treatment of primary gynecomastia in children and adolescents. 1994;21(3):539-543. To get insurance coverage, you'll probably need . Breast cancer found at the time of breast reduction. ul.ur li{ 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. Well-designed trials are especially important in assessing pain management interventions to isolate the contribution of the intervention from placebo effects, the effects of other concurrently administered pain management interventions, and the natural history of the medical condition. 2001;107(5):1234-1240. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. 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.
