aetna breast reduction requirements aetna breast reduction requirements

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. OL OL OL LI { A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. 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. of . Management of gestational gigantomastia. 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. Gynecomastia in patients with prostate cancer: A systematic review. Level of Evidence = III. 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). 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:. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. } The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). 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 Links to various non-Aetna sites are provided for your convenience only. Plast Reconstr Surg. Breast pumps. 2002;109(5):1556-1566. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. bottom: 20px; The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Breast reduction outcome study. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Marshall WA, Tanner JM. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Bland KI, Copeland EM, eds. width: 100%; 2008;61(5):493-502. 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. Mayo Clin Proc. Plast Reconstr Surg. 2017;35:157-161. There were only 2 studies of a total 25 patients that were considered as good in quality. In these cases, breast reduction for men may take 2 to 3 hours. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. 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. Aesthetic Plast Surg. 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). } Grooving where the bra straps sit on the shoulder. 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. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. padding-bottom: 4px; 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? Plastic surgery for teenagers briefing paper. padding: 10px; 2006;9(2):109-114. There were 18 out of 415 studies eligible to review. 2018;24(6):1043-1045. 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. 2007;36(2):497-519. Priorities Forum Policy Statement. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Ann Plastic Surg. A detailed physical examination, including testicular examination. N Engl J Med. 2020 Sep 4 [Online ahead of print]. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Plast Reconstr Surg. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. 2000;45(6):575-580. Ann Plast Surg. padding-right: 18px; Arlington Heights, IL: ASPS; 2011. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Am J Infect Control. The primary outcome was the difference in wound drainage over 24 hours. 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. This will be computed based on your body area. Arlington Heights, IL: ASPS; May 2011. 1991;27(3):232-237. 2006;118(4):840-848. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. All the patients recovered well and were satisfied with the cosmetic outcomes. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Plastic Reconstruct Surg. .strikeThrough { Measuring health state preferences in women with breast hypertrophy. Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. 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. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. } Please check your insurance policy to see whether breast reduction is a covered procedure. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Raispis T, Zehring RD, Downey DL. Emiroglu M, Salimoglu S, Karaali C, et al. Plast Reconstr Surg. Howrigan P. Reduction and augmentation mammoplasty. Kerrigan CL, Collins ED, Kim HM, et al. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or list-style-type: decimal; 2001;76(5):503-510. Plast Reconstr Surg. 1996;20(5):391-397. 1999;103(1):76-82; discussion 83-85. } Tang CL, Brown MH, Levine R, et al. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Hello! 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. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. } GP Notebook. Collis N, McGuiness CM, Batchelor AG. Plastic Reconstruct Surg. 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.. Plast Reconstr Surg. OL LI { 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). Nguyen JT, Wheatley MJ, Schnur PL, et al. The authors stated that operative subjects were told that their responses to the questionnaire were not to be used for insurance and thus the subjects had no motivation to exaggerate symptoms prior to surgery in questionnaire responses; however, it is not clear whether operative subjects would be willing to submit responses to a questionnaire from the doctor that differed substantially from the history that they provided to the doctor during their preoperative evaluation. 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). Ann Plast Surg. PLoS One. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. cursor: pointer; 1998;101(2):361-364. 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. font-size: 18px; These investigators searched the literature on the treatment of Simon's grade I and II gynecomastia in PubMed, Scopus, Science Direct, and Cochrane using keywords "gynecomastia" and "liposuction". The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 1995;95(1):77-83. background-color: #cc0066; Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. 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. 1998;49:215-234. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. 2015;49(6):311-318. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. The study subjects were stratified into groups based on ages of <60 years and 60 years. Copyright Aetna Inc. All rights reserved. Another set of breast pump supplies if you get pregnant . The nipple-areola complex was re-positioned in 60 % of patients (n = 54). ol.numberedList LI { hr.separator { Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. 2001;107(5):1234-1240. You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. .headerBar { Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). height:2px; Operative subjects who completed the study reported reductions in pain and improvements in quality of life; however, these improvements may be attributable to placebo effects, the natural history of back pain, other concurrent interventions, regression to the mean, improvements in cosmesis (for quality of life measures), or other confounding variables that may bias in interpretation of results. cursor: pointer; color:#eee; Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. 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. Determinants of surgical site infection after breast surgery. J Pediatr Surg. American Society of Plastic Surgeons (ASPS). ASPS clinical practice guideline summary on reduction mammaplasty. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. 2010;45(3):650-654. 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. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. background: #5e9732; The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Chadbourne EB, Zhang S, Gordon MJ, et al. Kerrigan CL, Collins ED, Kneeland TS, et al.