Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. A study by Bruhlmann and Tschopp (1998) was a retrospective study of 246 patients from a surgical practice, approximately 50 % (132) of whom returned a questionnaire about their symptoms and satisfaction with aesthetic results, and their recollection of symptoms prior to surgery. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. 2006;9(2):109-114. Plast Reconstr Surg. Ann Plast Surg. OL LI { Pain/discomfort/ulceration from bra straps cutting into shoulders; Skin breakdown (severe soft tissue infection, tissue necrosis, ulceration hemorrhage) from overlying breast tissue; There is a reasonable likelihood that the member's symptoms are primarily due to macromastia; Reduction mammoplasty (also spelled as 'mammaplasty') is likely to result in improvement of the chronic pain; Pain symptoms persist as documented by the physician despite at least a 3-month trial of therapeutic measures such as: Analgesic/non-steroidal anti-inflammatory drugs (NSAIDs) interventions and/or muscle relaxants, Dermatologic therapy of ulcers, necrosis and refractory infection, Physical therapy/exercises/posturing maneuvers, Supportive devices (e.g., proper bra support, wide bra straps), Chiropractic care or osteopathic manipulative treatment.
PDF Procedures, programs and drugs you must precertify - AmeriBen These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Surgeon. 2007;356(5):479-485. Recommended criteria for insurance coverage of reduction mammoplasty. Statistical analysis was performed with student t-test and chi-square test. of . He Q, Zheng L, Zhuang D, et al. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. With approval from the authors institutional ethics committee and written informed consent, a total of 22 patients with 33 abnormally hyperplastic breasts were enrolled at the First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. Surgical implications of obesity.
PDF 0185 Breast Reconstructive Surgery (1) - Aetna Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. breast augmentation with implant. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Reduction mammaplasty. 2003;111(2):688-694. Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). Flancbaum L, Choban PS. } No data were provided on loss to follow-up. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). 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. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. In a systematic review, these investigators examined the role of radiotherapy in this context. 2000;106(5):991-997. 2014a;34(1):66-73. The majority (87.7 %) of cases presented with accompanying mastalgia.
PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna Other just require 500 grams no matter what your height and weight. The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. 1993;91(7):1270-1276.
Breast Reduction Surgery | Johns Hopkins Medicine The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. 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. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. 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. 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). Plastic Reconstruct Surg. Krieger LM, Lesavoy MA. Schnur et al (1991) reported on a sliding scale assigns a weight of breast tissue to be removed based on body weight and surface area. 1991;27(3):232-237. J Plast Reconstr Aesthet Surg. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. 2005;58(3):286-289.
PDF A look at new changes coming to E&M and breast coding in 2021 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 . Last Review01/04/2023. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. A physician-supervised diet and exercise plan may be indicated in obese patients. Surgical management of gynecomastia--a 10-year analysis. width: 100%; position: fixed; These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. Mayo Clin Proc. The primary outcome was the difference in wound drainage over 24 hours. 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. Miller AP, Zacher JB, Berggren RB, et al. Plast Reconstr Surg. Reduction mammoplasty for macromastia. Schnur PL, Hoehn JG, Ilstrup DM, et al. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Obstet Gynecol Clin North Am. 2006;30(3):309-319. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. 01/04/2023 list-style-type: upper-roman; Plast Reconstr Surg. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. ASPS Recommended Coverage Criteria for Third Party Payors. Breast Concerns of Adolescents. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Plast Reconstr Surg. 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). #backTop:hover { 1996;20(5):391-397.
Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy.
How to make Aetna pay for your breast reduction surgery Sood R, Mount DL, Coleman JJ 3rd, et al. The authors reach the remarkable conclusion that a woman with normal sized breasts who has only a few ounces of breast tissue removed is as likely to receive as much benefit from breast reduction surgery as a women with large breasts who has substantially more breast tissue removed. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Pediatr Surg Int. 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 N Engl J Med. 1995;34(2):113-116. Emiroglu M, Salimoglu S, Karaali C, et al. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. 2018;89(6):408-412. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. #closethis { The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. 2014b;48(5):334-339. Marshall WA, Tanner JM. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Reduction mammoplasty for asymptomatic members is considered cosmetic. J Plast Surg Hand Surg. Level of Evidence = IV. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Follow-up ranged from 2 months to 3 years. 2000;44(2):125-134. 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. Seitchik MW. Plast Reconstr Surg. 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., breast size stable over one year) when any of the following criteria (A, B, or C) is met: Macromastia: all of the following criteria must be met: Aesthetic Plast Surg. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Endocrinol Metab Clin North Am. 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.
Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) 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). Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. 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. 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 individuals who received radiation treatment to the chest . padding: 10px; Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. 2012;130(4):785-789. 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:. This may lead to additional scarring and additional operating time. The mean age was 42.8 years (SD 19.5 years). list-style-type: decimal; Plast Reconstr Surg. .newText { Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty.
Does Health Insurance Cover Breast Reduction Surgery? - GoodRx Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). 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. 1998;101(2):361-364. In other patients, excess skin and nipple and areola relocation are necessary. } In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). 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. background-position: right 65%; Treatment of adolescent gynecomastia. color: blue
What are Aetna breast reduction requirements? - RealSelf.com li.bullet { Risk of bias was assessed independently by 2review authors. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Ann Plast Surg. 1999;103(6):1682-1686. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). display: none; Plast Reconstr Surg. Glatt BS, Sarwer DB, O'Hara DE, et al. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Level of Evidence = III. This Clinical Policy Bulletin may be updated and therefore is subject to change. And if you are in Canada the surgeon decides. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Aetna considers breast reconstructive surgery to correct 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.
Magnetic Resonance Imaging (MRI) of the Breast - Aetna These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). .strikeThrough {
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