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). Does Aetna Cover Breast Reduction? | HelpAdvisor.com 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. Kerrigan CL, Collins ED, Striplin D, et al. 2019;166(5):934-939. Breast Reduction Surgery | Johns Hopkins Medicine Gynecomastia may be drug-induced. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Sood R, Mount DL, Coleman JJ 3rd, et al. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Horm Res Paediatr. Reduction mammoplasty: Cosmetic or reconstructive procedure? Many men with breast enlargement are found to have pseudo-gynecomastia. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Miller AP, Zacher JB, Berggren RB, et al. J Pediatr Surg. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Reduction mammaplasty: The need for prospective randomized studies. PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna } Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). 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%. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). display: none; 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. American Society of Plastic Surgeons (ASPS). 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. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. list-style-type: lower-roman; American Society of Plastic Surgeons (ASPS). They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. } 2015;10(8):e0136094. Ann Plast Surg. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). Breast asymmetries: A brief review and our experience. The health burden of breast hypertrophy. Annu Rev Med. Furthermore, the lack of an expected "dose-response" relationship between the amount of breast tissue removed and the magnitude of symptomatic relief in these studies raises questions about the validity of these studies and the effectiveness of breast reduction as a method of relieving shoulder and back pain. Pediatr Surg Int. Plastic Reconstruct Surg. Level of Evidence = IV. A systematic search of the published literature was performed. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. 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. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. 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). } Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 1996;20(5):391-397. Schnur PL, Schnur DP, Petty PM, et al. 1995;95(1):77-83. 2009;7(2):114-119. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Plastic Reconstr Surg. Mayo Clin Proc. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Plast Reconstr Surg. Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). The primary outcome was the difference in wound drainage over 24 hours. border-width:0; Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Plastic Reconstruct Surg. Subjects were compared to age-matched norms from another study cohort. Reduction mammaplasty: Defining medical necessity. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Plast Reconstr Surg. Glatt BS, Sarwer DB, O'Hara DE, et al. Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com 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. Kerrigan CL, Collins ED, Kim HM, et al. The authors concluded that the limited evidence available showed no significant benefit of using post-operative wound drains in reduction mammoplasty, although LOS may be shorter when drains are not used. } Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. 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. This investigators stated that these studies should include data from older individuals affected by gynecomastia and utilize valid tools of psychological measurement in order to better quantify the effect; elderly patients affected by the disease have been over-looked in the current research; more data on this subject could improve the pre-operative evaluation of these patients and help identify the patients who will benefit from treatment. 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. Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. A total of 244 out of 1,628 patients with the average age of 23.13 years. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. 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]. 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". Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor Treating providers are solely responsible for medical advice and treatment of members. 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. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. 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). Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. 2000;106(2):280-288. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Can objective predictors for operative success be identified? z-index: 99; 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. 2019;8(4):431-440. 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). 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 The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. J Plast Surg Hand Surg. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. Copyright Aetna Inc. All rights reserved. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. J Plast Reconstr Aesthet Surg. Magnetic Resonance Imaging (MRI) of the Breast - Aetna 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. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. 1997;185(6):593-603. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Breast Concerns of Adolescents. Plastic Reconstr Surg. My Experience of Having Breast Reduction Surgery - Health These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. PDF Summary of Proposed Aetna Medicare Advantage Agreement 2001;108(6):1591-1599. } Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. /* aetna.com standards styles for templates */ the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Ann Plast Surg. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. of . Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. Breast Reduction | American Society of Plastic Surgeons Washington, DC: ACOG; 2011:121-122. To get insurance coverage, you'll probably need . Plast Reconstr Surg. The authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). color: #FFF; Chadbourne EB, Zhang S, Gordon MJ, et al. Plast Reconstr Surg. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. N Engl J Med. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. 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. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Araco A, Gravante G, Araco F, et al. top: 0px; However, it is unclear if there is any evidence to support this practice. margin-top: 38px; 2013;71(5):471-475. Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. No data were provided on loss to follow-up. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Collis N, McGuiness CM, Batchelor AG. Obesity and complications in breast reduction surgery: Are restrictions justified? color:#eee; A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. 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. Treatment of adolescent gynecomastia. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Gland Surg. Reduction mammoplasty for asymptomatic members is considered cosmetic.