Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. He Q, Zheng L, Zhuang D, et al. Three review authors undertook independent screening of the search results. background-color: #cc0066; color: blue!important; right: 30px; Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. There were no restrictions on the basis of date or language of publication. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. } 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 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. Links to various non-Aetna sites are provided for your convenience only. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. 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. For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. list-style-type: upper-alpha; skin should not be excised horizontally below the inframammary fold. Mistry RM, MacLennan SE, Hall-Findlay EJ. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. .fixedHeaderWrap { Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. 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. Other just require 500 grams no matter what your height and weight. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Please check your insurance policy to see whether breast reduction is a covered procedure. .newText { A follow-up study of 105 women with breast cancer following reduction mammaplasty. Schnur PL, Hoehn JG, Ilstrup DM, et al. A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammoplasty regarding physical symptoms and body image. Plast Reconstr Surg. Collis N, McGuiness CM, Batchelor AG. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Last Review01/04/2023. 2008;32(1):38-44. Reduction mammoplasty for asymptomatic members is considered cosmetic. Risk of bias was assessed independently by 2review authors. Emiroglu M, Salimoglu S, Karaali C, et al. Hello! Administration of Benefits and Transition Responsibilities /* aetna.com standards styles for templates */ Scand J Plast Reconstr Hand Surg. 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. No statistically significant differences in the drainage, level of pain, size of open areas, clinical appearance, degree of scar pliability, or scar erythema were noted. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. 2014;20(3):274-278. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. 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). 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. Level of Evidence = IV. See Appendix for Table 1. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. 2001;107(5):1234-1240. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Prepubertal gynecomastia linked to lavender and tea tree oils. For many patients the psychological impact of the disease is substantial. PDF Procedures, programs and drugs you must precertify - AmeriBen } PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com .headerBar { Breast asymmetries: A brief review and our experience. Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) 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. All the patients recovered well and were satisfied with the cosmetic outcomes. ASPS Recommended Coverage Criteria for Third Party Payors. Arch Dis Child. 1999;103(1):76-82; discussion 83-85. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. In this study the National Surgical Quality Improvement Program data set was queried for the Current Procedural Terminology code 19318 from the years 2005 to 2010, with principal outcome measurements of wound complications, surgical site infections, and reoperations. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Reduction mammoplasty: Criteria for insurance coverage. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Endocrinol Metab Clin North Am. Plast Reconstr Surg. 2000;106(2):280-288. Fagerlund A, Cormio L, Palangi L, et al. background-color: #663399; Flancbaum L, Choban PS. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Asian J Surg. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Fischer JP, Cleveland EC, Shang EK, et al. Breast J. Marshall WA, Tanner JM. 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). Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Collins ED, Kerrigan CL, Kim M, et al. 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. Ann Plastic Surg. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Socioeconomic Committee Position Paper. Philadelphia, PA: W.B. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. 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. Also, there was no correlation between PR expression and 2D: 4D. 2001;108(6):1591-1599. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. } Aesthetic Plast Surg. Arlington Heights, IL: ASPS; March 9, 2002. Sugrue CM, McInerney N, Joyce CW, et al. Determinants of surgical site infection after breast surgery. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Setala L, Papp A, Joukainen S, et al. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Study subjects included 3538 patients with an average age of 43 years and body mass index of 31.6 kg/m(2) and most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes.The incidence of overall surgical complications was 5.1% and the incidence of major surgical complications was 2.1%. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. 2009;7(2):114-119. Breast Reduction | American Society of Plastic Surgeons Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. And if you are in Canada the surgeon decides. padding: 10px; Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass 2014b;48(5):334-339. Ann Plast Surg. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Blomqvist L, Eriksson A, Brandberg Y. border: none; It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. Can objective predictors for operative success be identified? Sood R, Mount DL, Coleman JJ 3rd, et al. A study by Bruhlmann and Tschopp (1998) was a retrospective study of 246 patients from a surgical practice, approximately 50 % (132) of whom returned a questionnaire about their symptoms and satisfaction with aesthetic results, and their recollection of symptoms prior to surgery. Bland KI, Copeland EM, eds. 1998;26(1):61-65. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Lonie S, Sachs R, Shen A, et al. The primary outcome was the difference in wound drainage over 24 hours. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. width: 100%; This will be computed based on your body area. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. The study subjects were stratified into groups based on ages of <60 years and 60 years. A total of 244 out of 1,628 patients with the average age of 23.13 years. Ann Plast Surg. J Plast Surg Hand Surg. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Plast Reconstr Surg. 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. Priorities Forum Policy Statement. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Does Health Insurance Cover Breast Reduction Surgery? - GoodRx Kerrigan CL, Collins ED, Kim HM, et al. 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. A non-standardized survey showed a very high satisfaction index. 18th ed. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Current concepts in gynaecomastia. 2 . Gynecomastia has been classified into2 types. 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 Ann Plast Surg. Gynecomastia may be drug-induced. Aesthet Surg J. 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. 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. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. World J Surg. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Breast reduction for symptomatic macromastia. 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 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. Reduction mammaplasty. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. 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). In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Ann Chir Plast Esthet. 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. Is breast reduction covered by health insurance? | ASPS They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. Breast and aesthetic surgery. A detailed physical examination, including testicular examination. Variations in pattern of pubertal changes in girls. Plast Reconstr Surg. Type II gynecomastia is more generalized breast enlargement.

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