Aesthetic Plast Surg. and areola. Prepubertal gynecomastia linked to lavender and tea tree oils. The authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). Obstet Gynecol Clin North Am. 2000;106(2):280-288. 2009;7(2):114-119. Patient demographics, surgical technique, and outcomes were analyzed. 2006;9(2):109-114. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Yao Y, Yang Y, Liu J, et al. 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. Many men with breast enlargement are found to have pseudo-gynecomastia. American Society of Plastic Surgeons (ASPS). Surgical management of gynecomastia--a 10-year analysis. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. 2018;7(Suppl 1):S70-S76. Resolution of idiopathic gynecomastia may take several months to years. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. Coding Grooving where the bra straps sit on the shoulder. 1999;103(6):1674-1681. 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. Plast Reconstr 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. 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 Obesity and complications in breast reduction surgery: Are restrictions justified? This conclusion is based primarily upon the Breast Reduction Assessment of Value and Outcomes (BRAVO) study, which is described in several articles (Kerrigan et al, 2001; Kerrigan et al, 2002; Collins et al, 2002). Arlington Heights, IL: ASPRS; 1987. 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. background-color: #663399; Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. 1993;17(3):211-223. Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. Fischer S, Hirsch T, Hirche C, et al. 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: The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. 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. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Plastic surgery for teenagers briefing paper. Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. Macromastia: all . 2012;69(5):510-515. text-decoration: underline; These preliminary findings need to be validated by well-designed studies. background-color: #cc0066; 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). 18th ed. padding-bottom: 4px; 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. Bertin ML, Crowe J, Gordon SM. 2020 Sep 4 [Online ahead of print]. 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. 2007;119(4):1159-1166. 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. Socioeconomic Committee Position Paper. Schnur PL, Hoehn JG, Ilstrup DM, et al. 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. Please check your insurance policy to see whether breast reduction is a covered procedure. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. } Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. 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 . 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). Priorities Forum Policy Statement. Chadbourne EB, Zhang S, Gordon MJ, et al. 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). Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. 1995;34(2):113-116. 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. # font-weight: bold; To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). z-index: 99; 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). Ann Plast Surg. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. list-style-type: decimal; } Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). display: block; border-radius: 4px; 2002;109(5):1556-1566. Emiroglu M, Salimoglu S, Karaali C, et al. 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). 2021 Aug 11 [Online ahead of print]. 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. Reduction mammoplasty: Criteria for insurance coverage. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Brown DM, Young VL. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. 2021;147(5):1072-1083. 2015;10(8):e0136094. Plast Reconstr Surg. Links to various non-Aetna sites are provided for your convenience only. Level of Evidence = III. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. Breast reduction for symptomatic macromastia. The majority (87.7 %) of cases presented with accompanying mastalgia. .strikeThrough { 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). 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. 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. Computed tomography scan of adrenal glands to identify adrenal lesions. Annu Rev Med. Breast reduction outcome study. This Clinical Policy Bulletin may be updated and therefore is subject to change. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. 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). Sugrue CM, McInerney N, Joyce CW, et al. Reduction mammaplasty: An outcome study. The mean age was 42.8 years (SD 19.5 years). ul.ur li{ The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. .newText { Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Mayo Clin Proc. The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. bottom: 20px; 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. Surgeon. 2011;128(4):243e-249e. } 2004;113(1):436-437. Gynecomastia in patients with prostate cancer: Update on treatment options. list-style-type: upper-roman; OL OL OL OL LI { For many patients the psychological impact of the disease is substantial. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. 1995;61(11):1001-1005. 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. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. A total of 244 out of 1,628 patients with the average age of 23.13 years. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Prostate Cancer Prostatic Dis. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Khan SM, Smeulders MJ, Van der Horst CM. 2018;89(6):408-412. Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years). Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. A total of 15 articles met the inclusion criteria for review. There were only 2 studies of a total 25 patients that were considered as good in quality. Treating providers are solely responsible for medical advice and treatment of members. 1969;44(235):291-303. Policy. A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. #backTop { Burns JL, Blackwell SJ. 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).