The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. } Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Kerrigan CL, Collins ED, Kim HM, et al. Macromastia: all . 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. J Plast Reconstr Aesthet Surg. The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline # font-weight: bold; Am Surg. 1969;44(235):291-303. breast augmentation with implant. Also, there was no correlation between PR expression and 2D: 4D. background: #5e9732; (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) 1995;95(1):77-83. Ann Plast Surg. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. Subjects were compared to age-matched norms from another study cohort. ASPS Recommended Coverage Criteria for Third Party Payors. 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. 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). color: #FFF; 2018;24(6):1043-1045. This will be computed based on your body area. 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. Last Review01/04/2023. } Plastic Reconstr Surg. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Burdette TE, Kerrigan CL, Homa KA. Breast Reduction Surgery | Johns Hopkins Medicine 2001;76(5):503-510. A total of 15 articles met the inclusion criteria for review. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Setala L, Papp A, Joukainen S, et al. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. ul.ur li{ Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. Is breast reduction covered by health insurance? | ASPS Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 2004;113(1):436-437. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. American Society of Plastic Surgeons (ASPS). Policy. The mean volume of tissue resected was 250 g (range of 22 to 758 g) from the right breast and 244 g (range of 15 to 705 g) from the left breast. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Emiroglu M, Salimoglu S, Karaali C, et al. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. Brown MH, Weinberg M, Chong N, et al. These investigators searched the literature on the treatment of Simon's grade I and II gynecomastia in PubMed, Scopus, Science Direct, and Cochrane using keywords "gynecomastia" and "liposuction". Many men with breast enlargement are found to have pseudo-gynecomastia. Long-term functional results after reduction mammoplasty. Aesthetic Plast Surg. A cohort study of breast cancer risk in breast reduction patients. Determinants of surgical site infection after breast surgery. 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. What can I do if my insurance denies coverage for breast reduction? An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Mental health care professionals may be consulted to address psychological distress from gynecomastia. How to Get Your Breast Reduction Covered By Insurance - RealSelf News N Engl J Med. The study subjects were stratified into groups based on ages of <60 years and 60 years. Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? Wound drainage after plastic and reconstructive surgery of the breast. 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 . 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Surgeon. Gynecomastia in patients with prostate cancer: A systematic review. 2019;8(4):431-440. 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: Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. He Q, Zheng L, Zhuang D, et al. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna 2021;74(11):3128-3140. Plastic Reconstr Surg. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. In a systematic review, these investigators examined the role of radiotherapy in this context. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. In the case of breast reduction, however, for insurance purposes, it . 2018;89(6):408-412. Arlington Heights, IL: ASPRS; 1987. Level of Evidence = IV. --> Plast Reconstr Surg. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Bland KI, Copeland EM, eds. As explained below, the studies used to support the arguments for the medical necessity of breast reduction surgery are poorly controlled and therefore subject to a substantial risk of bias in the interpretation of results. 2009;62(2):195-199. Miller AP, Zacher JB, Berggren RB, et al. Fischer JP, Cleveland EC, Shang EK, et al. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . padding: 15px; Hello! The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. Asian J Surg. #closethis { With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an out-patient; however, this was not statistically significant (p = 0.07). 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). Obesity and complications in breast reduction surgery: Are restrictions justified? Endocrinol Metab Clin North Am. The end-point was the complete resolution of gynecomastia. Coding The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Plast Reconstr Surg. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. } Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. (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. J Plast Surg Hand Surg. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Mizgala CL, MacKenzie KM. 2 . 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. For individuals who received radiation treatment to the chest . 2014a;34(1):66-73. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. 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. 1998;41(3):240-245. 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. 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). Kasielska-Trojan A, Danilewicz M, Antoszewski B. 2011;128(4):243e-249e. } Prostate Cancer Prostatic Dis. 2014b;30(6):641-647. Breast reduction outcome study. Other just require 500 grams no matter what your height and weight. Townsend: Sabiston Textbook of Surgery. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Magnetic Resonance Imaging (MRI) of the Breast - Aetna 1998;49:215-234. Mistry RM, MacLennan SE, Hall-Findlay EJ. Hoyos AE, Perez ME, Dominguez-Millan R, et al. margin-top: 38px; Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Ann Plast Surg. 2008;53(3):255-261. Nelson et al (2014b) separately conducted a population level analysis of the 2005-2011 NSQIP datasets, identifying patient who underwent reduction mammoplasty, to determine the impact of obesity on early complications after reduction mammoplasty. Breast asymmetries: A brief review and our experience. 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. 2002;33:208-217. 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. Rising Rates of Insurance Denial for Breast Reduction Surgery Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. Breast J. 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 Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. top: 0px; 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. 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. Plastic surgery for teenagers briefing paper. color: red 2000;106(5):991-997. In other patients, excess skin and nipple and areola relocation are necessary. Refer to the member's specific plan document for applicable coverage. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Plastic Reconstruct Surg. J Pediatr 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. cursor: pointer; Plast Reconstr Surg. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). Plast Reconstr Surg. The health burden of breast hypertrophy. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. 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).