The primary outcome was the difference in wound drainage over 24 hours. 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. In addition, Nguyen et al (2004) ignored a wealth of published evidence of the effectiveness of physical therapy, analgesics and other conservative measures on back and neck pain generally. Aesthet Surg J. For many patients the psychological impact of the disease is substantial. Plast Reconstr Surg. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Tang CL, Brown MH, Levine R, et al. 2 . Policy. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. J Plast Reconstr Aesthet Surg. 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. } Leclere FM, Spies M, Gohritz A, Vogt PM. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. Kalliainen LK; ASPS Health Policy Committee. He Q, Zheng L, Zhuang D, et al. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. 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. 2001;76(5):503-510. Collins ED, Kerrigan CL, Kim M, et al. 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. } Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Often times, insurance company will dictate how much breast tissue to be removed. } 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). 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. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Ann Plast Surg.
Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna .
Breast Reduction Surgery | Johns Hopkins Medicine Seitchik MW. 2007;119(4):1159-1166. Br J Plast Surg. 2008;61(5):493-502. Asian J Surg. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Plast Reconstr Surg. Kerrigan CL, Collins ED, Kim HM, et al. list-style-type: lower-alpha; Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. OL LI { 2001;108(6):1591-1599. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Burdette TE, Kerrigan CL, Homa KA. 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. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. American Society of Plastic Surgeons (ASPS). Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. However, these medications should be reserved for those with no decrease in breast size after 2 years. Marshall WA, Tanner JM. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. 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). J Pediatr Surg. Aesthet Surg J. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 1993;91(7):1270-1276. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. 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. No author listed. 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. (25 y/o female with a 38J bra size) according to aetna, I should more than qualify for a reduction as I have back, neck, shoulder pain, chest pain and pressure, arm numbness while laying on sides, etc. 1999;103(6):1674-1681. Arlington Heights, IL: ASPRS; 1987. Reduction mammaplasty: Defining medical necessity. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. 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. 2001;108(1):62-67. right: 30px; list-style-type: lower-roman; Also, there was no correlation between PR expression and 2D: 4D. Level of Evidence = III. 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). Reduction mammaplasty: An outcome study. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Please check your insurance policy to see whether breast reduction is a covered procedure. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. A non-standardized survey showed a very high satisfaction index. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Management of gestational gigantomastia. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. 1999;103(6):1682-1686. 2005;55(3):227-231. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Krieger LM, Lesavoy MA. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. } Plastic Reconstruct Surg. list-style-type: upper-roman; Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. In a systematic review, these investigators examined the role of radiotherapy in this context. 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 et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. and areola. Breast J. Women's Health and Cancer Rights Act of 1998. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. Breast asymmetries: A brief review and our experience. 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 . Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). } The following procedures are considered experimental and investigational because there is insufficient evidence of itseffectiveness or itseffectiveness has not been established: Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. Ann Plast Surg. In the case of breast reduction, however, for insurance purposes, it . The Mammotome procedure represented another novel therapeutic option for gynecomastia. Ann Plast Surg. Mizgala CL, MacKenzie KM. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; 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 Surgical management of gynecomastia--a 10-year analysis. A total of 90 patients underwent breast re-reduction surgery. The risks included infection, wound breakdown, scarring, and the need for re-operating. Schnur PL, Hoehn JG, Ilstrup DM, et al. 2013;71(5):471-475. Current concepts in gynaecomastia. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. .fixedHeaderWrap { Aesthet Plastic Surg. This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. Li CC, Fu JP, Chang SC, et al. Plastic Reconstr Surg. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Arch Dis Child. 2014;20(3):274-278. 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.. 1990;24(1):61-67. Oxfordshire NHS Trust. Gynecomastia. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. All patients underwent routine investigations to exclude secondary causes of gynecomastia. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Long-term functional results after reduction mammoplasty. Scand J Plast Reconstr Hand Surg. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Fischer JP, Cleveland EC, Shang EK, et al. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders.
Does Health Insurance Cover Breast Reduction Surgery? - GoodRx 2015;49(6):311-318. J Plast Reconstr Aesthet Surg. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. 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. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. A total of 15 articles met the inclusion criteria for review. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? color: red Plast Reconstr Surg. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. 2014a;34(1):66-73. color: red!important; Yao Y, Yang Y, Liu J, et al. 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. Reduction mammaplasty provides long-term improvement in health status and quality of life. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. padding: 15px; 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 } Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. 1995;95(6):1029-1032. Chadbourne EB, Zhang S, Gordon MJ, et al. 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. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Follow-up ranged from 2 months to 3 years. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. ol.numberedList LI { In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Lonie S, Sachs R, Shen A, et al. 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. Miller AP, Zacher JB, Berggren RB, et al. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. 1993;17(3):211-223. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Glatt BS, Sarwer DB, O'Hara DE, et al. Drainage in breast reduction surgery: A prospective randomised intra-patient trail.
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