Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Gland Surg. He Q, Zheng L, Zhuang D, et al. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Breast and aesthetic surgery. padding: 10px; 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. --> High-risk lesions (atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], and lobular carcinoma in situ [LCIS]) were revealed in 37 (11.7 %), and cancer in 6 (1.9 %) patients. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). 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. right: 30px; Reduction mammoplasty improves symptoms of macromastia. 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. } 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. Patient demographics, surgical technique, and outcomes were analyzed. Links to various non-Aetna sites are provided for your convenience only. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Med Decis Making. 1997;185(6):593-603. 2004;113(1):436-437. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. 01/04/2023 } This may lead to additional scarring and additional operating time. Plastic Reconstr Surg. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. background-color: #cc0066; 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]. 2002;33:208-217. hr.separator { bottom: 20px; Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? Saunders Co.; 1991. text-decoration: line-through; Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Plast Reconstr Surg. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. 2011;128(4):243e-249e. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. 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. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Arlington Heights, IL: ASPS; May 2011. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. } Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. 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. 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). Annu Rev Med. color: white; However, these medications should be reserved for those with no decrease in breast size after 2 years. } 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. Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). 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. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. 2009;62(2):195-199. 2020 Sep 4 [Online ahead of print]. 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. 2017;139(6):1313-1322. padding-bottom: 4px; The primary outcome was the difference in wound drainage over 24 hours. 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. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Ann Chir Plast Esthet. Aesthet Surg J. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? 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. 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). Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna } 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:. 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 Plast Reconstr Surg. } Plastic Reconstruct Surg. Evidence-based clinical practice guideline: Reduction mammaplasty. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Copyright Aetna Inc. All rights reserved. Washington, DC: ACOG; 2011:121-122. A detailed physical examination, including testicular examination. Gynecomastia in patients with prostate cancer: A systematic review. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. Arch Dis Child. Chadbourne EB, Zhang S, Gordon MJ, et al. 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. } list-style-type: upper-roman; Level of Evidence = IV. 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. Fischer JP, Cleveland EC, Shang EK, et al. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Level of Evidence = III. Does Health Insurance Cover Breast Reduction Surgery? - GoodRx