2008;121(4):1092-1100. The Mammotome procedure represented another novel therapeutic option for gynecomastia. 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. Plast Reconstr Surg. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. color: blue!important; 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. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract.
Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . 2013;71(5):471-475. Scand J Plast Reconstr Hand Surg. 2014;20(3):274-278. Gland Surg. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. 2007;356(5):479-485. The mean age was 42.8 years (SD 19.5 years). In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. J Laparoendosc Adv Surg Tech A. padding-right: 18px; The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. Gynecomastia: Evolving paradigm of management and comparison of techniques. 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. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. list-style-type: decimal; 2009;7(2):114-119. Surg Laparosc Endosc Percutan Tech. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Level of Evidence = III. 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. A cohort study of breast cancer risk in breast reduction patients. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Ann Plast Surg. Kerrigan CL, Collins ED, Kim HM, et al. 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. # font-weight: bold; Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. } In a systematic review, these investigators examined the role of radiotherapy in this context. Ann Plast Surg. 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). Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. list-style-type: upper-alpha; The health burden of breast hypertrophy. American Society of Plastic and Reconstructive Surgery (ASPRS). Risk of bias was assessed independently by 2review authors. 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). Many men with breast enlargement are found to have pseudo-gynecomastia. Breast asymmetries: A brief review and our experience. Macromastia: all . 2019;8(4):431-440. This will be computed based on your body area. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. 2006;9(2):109-114. Risk factors for complications following breast reduction: Results from a randomized control trial. Ann Plast Surg. 1995;34(2):113-116. OL OL OL OL OL LI { 2000;106(5):991-997. 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. font-size: 18px; J Plast Reconstr Aesthet Surg. Aetna considers breast reduction surgery medically necessary for non-cosmetic indications for women aged 18 or older or for whom growth is complete (i.e., breast size stable over one year) when any of the following criteria (A, B, or C) is met: Macromastia: all of the following criteria must be met: 01/04/2023 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. }
How to make Aetna pay for your breast reduction surgery First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. And if you are in Canada the surgeon decides. Plast Reconstr Surg. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Management of gestational gigantomastia. Arlington Heights, IL: ASPS; 2011. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. ASPS clinical practice guideline summary on reduction mammaplasty. 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. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty.
What can I do if my insurance denies coverage for breast reduction? Oxfordshire NHS Trust. cursor: pointer; 2001;76(5):503-510. } Gonzalez FG, Walton RL, Shafer B, et al. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. Obesity and complications in breast reduction surgery: Are restrictions justified? 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.