1998;26(1):61-65. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. Mayo Clin Proc. Aesthet Surg J. Reduction mammaplasty: Defining medical necessity. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Mental health care professionals may be consulted to address psychological distress from gynecomastia. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna A total of 81 patients were included in this study. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Breast J. 1996;20(5):391-397. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Br J Plast Surg. Gland Surg. Emiroglu M, Salimoglu S, Karaali C, et al. 1999;103(6):1674-1681. 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). Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. 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. Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. Breast Reduction Surgery | Johns Hopkins Medicine 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. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. J Plast Surg Hand Surg. z-index: 99; Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. What are Aetna breast reduction requirements? - RealSelf.com Gynecomastia: A systematic review. The mean volume of tissue resected was 250 g (range of 22 to 758 g) from the right breast and 244 g (range of 15 to 705 g) from the left breast. Risk of bias was assessed independently by 2review authors. Tang CL, Brown MH, Levine R, et al. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. ASPS Recommended Coverage Criteria for Third Party Payors. 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). Krieger LM, Lesavoy MA. 2014a;34(3):409-416. Breast J. CG-SURG-71 Reduction Mammaplasty - Anthem Level of Evidence = IV. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. 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). There were only 2 studies of a total 25 patients that were considered as good in quality. 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., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Evidence-based clinical practice guideline: Reduction mammaplasty. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Prostate Cancer Prostatic Dis. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Another set of breast pump supplies if you get pregnant . } Flancbaum L, Choban PS. 2000;106(2):280-288. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. 1998;101(2):361-364. 1993;91(7):1270-1276. 2001;108(1):62-67. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. 1994;21(3):539-543. You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. Araco A, Gravante G, Araco F, et al. 2001;76(5):503-510. No data were provided on loss to follow-up. 2018;89(6):408-412. Schnur PL, Hoehn JG, Ilstrup DM, et al. 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. Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. 2000;45(6):575-580. Socioeconomic Committee Position Paper. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. A population-level analysis of bilateral breast reduction: does age affect early complications? Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. height:2px; A total of 15 articles met the inclusion criteria for 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 . Surgical implications of obesity. #backTop:hover { 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. Ann Chir Plast Esthet. Sood R, Mount DL, Coleman JJ 3rd, et al. 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? These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. Other just require 500 grams no matter what your height and weight. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. However, it is unclear if there is any evidence to support this practice. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Priorities Forum Policy Statement. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. Reduction mammaplasty. OL OL OL OL LI { Administration of Benefits and Transition Responsibilities How to Get Your Breast Reduction Covered By Insurance - RealSelf News Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. 2012;130(4):785-789. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Abnormal histopathological findings were more frequent in patients with reduction mammoplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). 2014a;34(1):66-73. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. 1969;44(235):291-303. Measuring health state preferences in women with breast hypertrophy. Can objective predictors for operative success be identified? They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. 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).
