2012;69(5):510-515. 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). OL OL OL OL LI { Administration of Benefits and Transition Responsibilities background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; text-decoration: underline; } Coding Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. 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. background-position: right 65%; J Plast Surg Hand Surg. 2018;89(6):408-412. Plast Reconstr Surg. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. of the following criteria must be met: 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. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Autorino R, Perdona S, D'Armiento M, et al. 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. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Scand J Plast Reconstr Hand 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). Computed tomography scan of adrenal glands to identify adrenal lesions. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Can objective predictors for operative success be identified? Ann Plast Surg. For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Mistry RM, MacLennan SE, Hall-Findlay EJ. 2009;7(2):114-119. He Q, Zheng L, Zhuang D, et al. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . Refer to the member's specific plan document for applicable coverage. 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. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. 2010;125(5):1301-1308. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Recommended criteria for insurance coverage of reduction mammoplasty. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Breast J. The study subjects were stratified into groups based on ages of <60 years and 60 years. }. 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: Safran T, Abi-Rafeh J, Alabdulkarim A, et al. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Ann Plastic Surg. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Because reduction mammoplasty may be used for both medically necessary and cosmetic indications, Aetna has set forth above objective criteria to distinguish medically necessary reduction mammoplasty from cosmetic reduction mammoplasty. Sood R, Mount DL, Coleman JJ 3rd, et al. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Reduction mammoplasty: Cosmetic or reconstructive procedure? Long-term functional results after reduction mammoplasty. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. text-decoration: line-through; OL OL LI { For individuals who received radiation treatment to the chest . The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. color: blue .headerBar { 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. 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. The authors (Nguyen et al, 2004) argue, based primarily on the results of the ASPS-funded BRAVO study (described below), that (with a single exception) no objective criteria for breast reduction surgery are supportable, including criteria based upon the presence of particular signs or symptoms, requirements based upon breast size or the amount of breast tissue removed, any minimum age limitations, any limitation based upon maximum body weight, requirements for a trial of conservative therapy, or the exclusion of certain procedures (liposuction). Level of Evidence = IV. For medical Breast. #closethis { The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Abnormalities in Adolescent Breast Development. Reduction mammoplasty for macromastia. 2006;30(3):309-319. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. 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. Cochrane Database Syst Rev. Chadbourne EB, Zhang S, Gordon MJ, et al. Fischer S, Hirsch T, Hirche C, et al. 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). 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. Ann Plast Surg. margin-top: 38px; Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Li CC, Fu JP, Chang SC, et al. Reduction mammoplasty for asymptomatic members is considered cosmetic. z-index: 99; } 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., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. 2000;45(6):575-580. Plast Reconstr Surg. Am J Infect Control. 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. 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. 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. A detailed physical examination, including testicular examination. This may lead to additional scarring and additional operating time. 1995;34(2):113-116. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Links to various non-Aetna sites are provided for your convenience only. Breast Concerns of Adolescents. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. All the patients recovered well and were satisfied with the cosmetic outcomes. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. 2012;130(4):785-789. 1997;185(6):593-603. 2001;107(5):1234-1240. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Krieger LM, Lesavoy MA. 2001;108(6):1591-1599. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. list-style-type: decimal; Bertin ML, Crowe J, Gordon SM. Burns JL, Blackwell SJ. Handschin AE, Bietry D, Hsler R, et al. Breast reduction outcome study. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Exposure to partners using estrogen containing vaginal creams; Cancer chemotherapy (alkylating agents, methotrexate, vinca alkaloids, imatinib, combination chemotherapy), Androgen receptor blockers - bicalutamide, 5 reductase inhibitors - finasteride, dutasteride, Angiotensin converting enzyme inhibitors (captopril, enalapril), Calcium channelblockers(diltiazem, nifedipine, verapamil), Anabolic steroids(e.g., in body builders). skin should not be excised horizontally below the inframammary fold. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Am Surg. A total of 90 patients underwent breast re-reduction surgery. Devalia HL, Layer GT. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Raispis T, Zehring RD, Downey DL. 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). Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. 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 . A population-level analysis of bilateral breast reduction: does age affect early complications? Plastic surgery for teenagers briefing paper. Ann Plast Surg. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. 2019;8(4):431-440. 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. Ann Plast Surg. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Principles of breast re-reduction: A reappraisal. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. The health burden of breast hypertrophy. J Plast Reconstr Aesthet Surg. Marshall WA, Tanner JM. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Also, there was no correlation between PR expression and 2D: 4D. Gynaecomastia. 1. Ann Plastic Surg. .newText { Yao Y, Yang Y, Liu J, et al. Surgical treatment is indicated when medical treatments fail. 2008;61(5):493-502. Disproportionately large breasts can cause both physical and emotional . From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device.
Accident On 95 North Yesterday,
Hoi4 Millennium Dawn Best Countries,
Powershell Command To Run Batch File As Administrator,
Distinguished Honor Graduate Army Ait,
St Landry Parish School Board Employee Portal,
Articles A