Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. 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). J Plast Surg Hand Surg. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. background: #5e9732; Aesthet Plastic Surg. 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 Plastic Reconstruct Surg. 2012;130(4):785-789. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . and areola. Plast Reconstr Surg. 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:. 2008;121(4):1092-1100. A non-standardized survey showed a very high satisfaction index. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Philadelphia, PA: W.B. 2013;71(5):471-475. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. 2005;58(3):286-289. A physician-supervised diet and exercise plan may be indicated in obese patients. Obesity and complications in breast reduction surgery: Are restrictions justified? The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. Analysis was on an intention-to-treat basis. 2007;119(4):1159-1166. Seitchik MW. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Links to various non-Aetna sites are provided for your convenience only. Cochrane Database Syst Rev. 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. In the case of breast reduction, however, for insurance purposes, it . Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. 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. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Sugrue CM, McInerney N, Joyce CW, et al. For many patients the psychological impact of the disease is substantial. Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia. Blomqvist L, Eriksson A, Brandberg Y. 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. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. 1995;61(11):1001-1005. Flancbaum L, Choban PS. Raispis T, Zehring RD, Downey DL. Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. Statistical analysis was performed with student t-test and chi-square test. Principles of breast re-reduction: A reappraisal. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. 2014a;34(1):66-73. In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. Special Clinical Concerns. Howrigan P. Reduction and augmentation mammoplasty. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. 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. 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. Plast Reconstr Surg. Oxfordshire NHS Trust. 2001;107(5):1234-1240. Bertin ML, Crowe J, Gordon SM. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. } Plast Reconstr Surg. 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. border: none; 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. .headerBar { Ann Plast Surg. 1999;103(6):1682-1686. All RCTs that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. 1995;95(6):1029-1032. 2018;89(6):408-412. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Asian J Surg. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). } Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. The Mammotome procedure represented another novel therapeutic option for gynecomastia. 2012;69(5):510-515. Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. 1998;101(2):361-364. Breast reduction for symptomatic macromastia. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. 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. 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. Reduction mammaplasty. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. In other patients, excess skin and nipple and areola relocation are necessary. 2000;106(5):991-997. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. color: blue 1. 2010;125(5):1301-1308. margin-top: 38px; Plast Reconstr Surg. Fagerlund A, Cormio L, Palangi L, et al. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Refer to the member's specific plan document for applicable coverage. hr.separator { All studies on the subject were evaluated for inclusion and 6 studies were included in the review. 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). Schnur PL, Hoehn JG, Ilstrup DM, et al. 1995;95(1):77-83. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Other just require 500 grams no matter what your height and weight. 2006;9(2):109-114. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Burns JL, Blackwell SJ. J Plast Reconstr Aesthet Surg. list-style-type: upper-roman; Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. } Reduction mammoplasty: Cosmetic or reconstructive procedure? } 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. This may lead to additional scarring and additional operating time. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Plast Reconstr Surg. 18th ed. Breast. 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. In a review on Surgical treatment of primary gynecomastia in children and adolescents, Fischer et al (2014b) concluded that surgical correction of gynecomastia remains a purely elective intervention. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Ages ranged from 18 to 66 years. outline: none; The end-point was the complete resolution of gynecomastia. They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. # color: white; Am J Infect Control. Ann Plast Surg. .fixedHeaderWrap { Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. 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. 2004;113(1):436-437. 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). Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . 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. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. 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. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Plastic Reconstr Surg. 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.