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. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Gland Surg. Reduction mammaplasty: A review of managed care medical policy coverage criteria. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 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. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Araco A, Gravante G, Araco F, et al. 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. The end-point was the complete resolution of gynecomastia. z-index: 99; Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Nguyen JT, Wheatley MJ, Schnur PL, et al. Although the BRAVO study nominally included a "control group", there was no comparison group of subjects selected from the same cohort, who were randomized or otherwise appropriately assigned to reduce bias, and treated with conservative management according to a protocol to ensure optimal conservative care. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Collis N, McGuiness CM, Batchelor AG. Br J Plast Surg. Risk factors for complications following breast reduction: Results from a randomized control trial. Washington, DC: ACOG; 2011:121-122. Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy. Handschin AE, Bietry D, Hsler R, et al. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Other just require 500 grams no matter what your height and weight. 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). Marshall WA, Tanner JM. In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Gonzalez FG, Walton RL, Shafer B, et al. color: red!important; list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Fagerlund A, Lewin R, Rufolo G, et al. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. #closethis { } Grooving where the bra straps sit on the shoulder. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 1. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Sabistons Textbook of Surgery (Burns & Blackwell, 2008)states that breast size should be stable for one year: There is no set lower age limit but, for the adolescent with breast hypertrophy, reduction is deferred until the breasts have stopped growing and are stable in size for at least 12 months before surgery.. Ann Plast Surg. top: 0px; PDF 0185 Breast Reconstructive Surgery (1) - Aetna Magnetic Resonance Imaging (MRI) of the Breast - Aetna All patients underwent routine investigations to exclude secondary causes of gynecomastia. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna 1969;44(235):291-303. 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). The risks included infection, wound breakdown, scarring, and the need for re-operating. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. breast augmentation with implant. Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. 1997;185(6):593-603. Breast pumps. 2002;109(5):1556-1566. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. 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. PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Autorino R, Perdona S, D'Armiento M, et al. 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. Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Surgical implications of obesity. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Obstet Gynecol Clin North Am. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Surgical treatment is indicated when medical treatments fail. Breast cancer found at the time of breast reduction. Breast J. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. 2008;61(5):493-502. There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). Plast Reconstr Surg. Computed tomography scan of adrenal glands to identify adrenal lesions. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. } Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. list-style-type: decimal; Resolution of idiopathic gynecomastia may take several months to years. Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. Mayo Clin Proc. hr.separator { Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. 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. 2018;24(6):1043-1045. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. In: Townsend CM, Beuchamp RD, Evers BM, eds. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. 2002;33:208-217. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. Breast asymmetries: A brief review and our experience. Evidence-based clinical practice guideline: Reduction mammaplasty. Plast Reconstr Surg. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Ages ranged from 18 to 66 years. 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 There were 18 out of 415 studies eligible to review. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Plast Reconstr Surg. Well-designed clinical trials provide reliable information about the effectiveness of an intervention, and provide valid information about the characteristics of patients who would benefit from that intervention. 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. 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. 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. color: red Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary.

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