aetna breast reduction requirements

Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Surgical implications of obesity. In addition, Nguyen et al (2004) ignored a wealth of published evidence of the effectiveness of physical therapy, analgesics and other conservative measures on back and neck pain generally. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Washington, DC: ACOG; 2011:121-122. /* aetna.com standards styles for templates */ 2012;69(5):510-515. J Plast Surg Hand Surg. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. 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). There were no restrictions on the basis of date or language of publication. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Schnur PL, Hoehn JG, Ilstrup DM, et al. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. 2015;49(6):311-318. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. 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. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. Ann Plast Surg. Principles of breast re-reduction: A reappraisal. Breast reduction outcome study. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. 1999;103(6):1674-1681. 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. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Little is known about the effect of surgical treatment on the psychological aspects of the disease. background-position: right 65%; Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Setala L, Papp A, Joukainen S, et al. Am Surg. A non-standardized survey showed a very high satisfaction index. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. 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. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). Aesthet Plastic Surg. These preliminary findings need to be validated by well-designed studies. To get insurance coverage, you'll probably need . Plast Reconstr Surg. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. } list-style-type: lower-roman; There were only 2 studies of a total 25 patients that were considered as good in quality. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. 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. Plast Reconstr Surg. Kerrigan CL, Collins ED, Striplin D, et al. 2021;147(5):1072-1083. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. 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. padding: 10px; Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. 2007;356(5):479-485. Gynecomastia. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. The authors concluded that the limited evidence available showed no significant benefit of using post-operative wound drains in reduction mammoplasty, although LOS may be shorter when drains are not used. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). World J Surg. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. When seeking preauthorization for a breast reduction, your goal is generally twofold. And if you are in Canada the surgeon decides. Yao Y, Yang Y, Liu J, et al. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures 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. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. OL OL OL OL LI { 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. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. 2015;49(6):363-366. } Reduction mammoplasty for macromastia. Reduction mammoplasty for asymptomatic members is considered cosmetic. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. z-index: 99; Mental health care professionals may be consulted to address psychological distress from gynecomastia. 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. 1998;26(1):61-65. Handschin AE, Bietry D, Hsler R, et al. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. This will be computed based on your body area. Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. @media print { Plast Reconstr Surg. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Two review authors undertook independent data extraction of study characteristics, methodological quality and outcomes (e.g., infection, other wound complications, pain, and length of hospital stay [LOS]). The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. 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. Aesthetic Plast Surg. of the following criteria must be met: Cochrane Database Syst Rev. J Laparoendosc Adv Surg Tech A. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. J Plast Reconstr Aesthet Surg. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Kerrigan CL, Collins ED, Kim HM, et al. No necrosis, systemic infection, or muscle paralysis was reported. 1996;20(5):391-397. In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). Gynecomastia is a very common concern of male adolescence. Plastic Reconstr Surg. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. padding-bottom: 4px; Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Ann Plast 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., 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. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Can objective predictors for operative success be identified? Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. 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.