Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Surgeon. list-style-type: decimal; 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. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). 2008;121(4):1092-1100. An 18-question survey was created evaluating various aspects of BBR practice; UK and Irish plastic and reconstructive and breast surgeons were invited to participate by an e-mail containing a link to a web-based survey. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. 2014a;34(3):409-416. padding: 15px; Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. 2021;74(11):3128-3140. Reduction mammoplasty: Criteria for insurance coverage. 1993;91(7):1270-1276. A systematic search of the published literature was performed. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Risk factors for complications following breast reduction: Results from a randomized control trial. No new trials were identified for this first update. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Major complications (1.6 %) included unilateral hematoma and localized infection. Marshall WA, Tanner JM. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. OL OL OL LI { .arrowPurpleSmall, a:hover.arrowPurpleSmall { Often times, insurance company will dictate how much breast tissue to be removed. 2015;75(4):383-387. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. All patients underwent routine investigations to exclude secondary causes of gynecomastia. } 2018;7(Suppl 1):S70-S76. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. PDF A look at new changes coming to E&M and breast coding in 2021 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. PLoS One. Aetna considers breast reconstructive surgery to correct Management of gestational gigantomastia. font-size: 18px; The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. 2008;53(3):255-261. Principles of breast re-reduction: A reappraisal. Breast reduction outcome study. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. 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. J Plast Reconstr Aesthet Surg. The study subjects were stratified into groups based on ages of <60 years and 60 years. There were only 2 studies of a total 25 patients that were considered as good in quality. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note A follow-up study of 105 women with breast cancer following reduction mammaplasty. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. There were 18 out of 415 studies eligible to review. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Breast Reduction Surgery | Johns Hopkins Medicine PDF Summary of Proposed Aetna Medicare Advantage Agreement 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. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. When seeking preauthorization for a breast reduction, your goal is generally twofold. Horm Res Paediatr. 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. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. 1995;95(6):1029-1032. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com 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. The end-point was the complete resolution of gynecomastia. 2014b;30(6):641-647. Subjects were compared to age-matched norms from another study cohort. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. 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. position: fixed; The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. .strikeThrough { 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. Other just require 500 grams no matter what your height and weight. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. The Breast: Comprehensive Management of Benign and Malignant Diseases. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Surgical treatment of primary gynecomastia in children and adolescents. Am J Infect Control. height:2px; padding: 10px; text-decoration: underline; 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. Kerrigan CL, Collins ED, Striplin D, et al. Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast. A detailed physical examination, including testicular examination. American Society of Plastic and Reconstructive Surgery (ASPRS). The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Plast Reconstr Surg. Ann Plast Surg. 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. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Plast Reconstr Surg. } The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. Magnetic Resonance Imaging (MRI) of the Breast - Aetna 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. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. 2017;35:157-161. OL OL OL OL LI { (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. 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. Computed tomography scan of adrenal glands to identify adrenal lesions. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. 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.