aetna breast reduction requirements aetna breast reduction requirements

Fischer S, Hirsch T, Hirche C, et al. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Reduction mammaplasty: Defining medical necessity. Resolution of idiopathic gynecomastia may take several months to years. 1998;101(2):361-364. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Other just require 500 grams no matter what your height and weight. A detailed physical examination, including testicular examination. 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). Safran T, Abi-Rafeh J, Alabdulkarim A, et al. There were no restrictions on the basis of date or language of publication. Plastic Reconstr Surg. 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. Plastic surgery for teenagers briefing paper. Treating providers are solely responsible for medical advice and treatment of members. 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]). 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. Breast reduction surgery - Mayo Clinic } This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Grooving where the bra straps sit on the shoulder. A total of 90 patients underwent breast re-reduction surgery. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Plastic Reconstr Surg. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Gynecomastia in patients with prostate cancer: A systematic review. He Q, Zheng L, Zhuang D, et al. Marshall WA, Tanner JM. The authors stated that operative subjects were told that their responses to the questionnaire were not to be used for insurance and thus the subjects had no motivation to exaggerate symptoms prior to surgery in questionnaire responses; however, it is not clear whether operative subjects would be willing to submit responses to a questionnaire from the doctor that differed substantially from the history that they provided to the doctor during their preoperative evaluation. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Another set of breast pump supplies if you get pregnant . Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. list-style-type: lower-alpha; Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. J Plast Reconstr Aesthet Surg. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Ann Plast Surg. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna 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. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. American Society of Plastic and Reconstructive Surgery (ASPRS). Wound drainage after plastic and reconstructive surgery of the breast. 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. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Raispis T, Zehring RD, Downey DL. Breast J. The Breast: Comprehensive Management of Benign and Malignant Diseases. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. Glatt BS, Sarwer DB, O'Hara DE, et al. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). .newText { Saunders Co.; 1991. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Level of Evidence = IV. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. When seeking preauthorization for a breast reduction, your goal is generally twofold. Seitchik MW. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. # color: white; Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . For many patients the psychological impact of the disease is substantial. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. padding-right: 18px; Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. 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). Plast Reconstr Surg. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. However, it is unclear if there is any evidence to support this practice. Krieger LM, Lesavoy MA. margin-top: 38px; Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. There were 18 out of 415 studies eligible to review. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Am Surg. 2003;111(2):688-694. Also, there was no correlation between PR expression and 2D: 4D. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Computed tomography scan of adrenal glands to identify adrenal lesions. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. 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. Burdette TE, Kerrigan CL, Homa KA. Plast Reconstr Surg. 2021;147(5):1072-1083. Tang CL, Brown MH, Levine R, et al. #backTop:hover { What can I do if my insurance denies coverage for breast reduction? } Araco A, Gravante G, Araco F, et al. Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. No new trials were identified for this first update. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Breast cancer found at the time of breast reduction. 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. Policy. border: none; The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Plastic Reconstruct Surg. Br J Plast Surg. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Scand J Plast Reconstr Hand Surg. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Reduction mammoplasty improves symptoms of macromastia. Plast Reconstr Surg. /*margin-bottom: 43px;*/ color:#eee; All studies on the subject were evaluated for inclusion and 6 studies were included in the review. 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: Obesity and complications in breast reduction surgery: Are restrictions justified? Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Policy Statement 6d: Aesthetic surgery procedures. 1993;17(3):211-223. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Nguyen JT, Wheatley MJ, Schnur PL, et al. 1999;103(1):76-82; discussion 83-85. Many men with breast enlargement are found to have pseudo-gynecomastia. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. J Plast Surg Hand Surg. Abnormalities in Adolescent Breast Development. A total of 15 articles met the inclusion criteria for review. The risks included infection, wound breakdown, scarring, and the need for re-operating. Long-term functional results after reduction mammoplasty. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). 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. In these cases, breast reduction for men may take 2 to 3 hours. 2002;109(5):1556-1566. The Mammotome procedure represented another novel therapeutic option for gynecomastia. Reduction mammaplasty: A review of managed care medical policy coverage criteria. list-style-type: upper-alpha; z-index: 99; } 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. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. 2001;108(1):62-67. 2000;44(2):125-134. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Reduction mammoplasty for asymptomatic members is considered cosmetic. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Qu S, Zhang W, Li S, et al. } OL OL OL LI { In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. N Engl J Med. 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. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne .arrowPurpleSmall, a:hover.arrowPurpleSmall { If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. The authorsleave the reader with the conclusionthat decisions about the medical necessity of breast reduction surgery in symptomatic women should be left entirely to the surgeon's discretion. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. 2007;356(5):479-485. Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna PDF Summary of Proposed Aetna Medicare Advantage Agreement Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. } Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Gynecomastia. list-style-type : square !important; 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. Measuring health state preferences in women with breast hypertrophy. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. ul.ur li{ Setala L, Papp A, Joukainen S, et al. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. OL LI { background-color:#eee; GP Notebook. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. 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. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 01/04/2023 A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Miller AP, Zacher JB, Berggren RB, et al. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Plastic Reconstruct Surg. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). The primary outcome was the difference in wound drainage over 24 hours. Ann Plast Surg. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Asian J Surg. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance).