text-decoration: underline; Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Reduction mammoplasty: Criteria for insurance coverage. Reduction mammaplasty: An outcome study. --> Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. 1999;103(6):1682-1686. height:2px; Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Arlington Heights, IL: ASPS; March 9, 2002. There were only 2 studies of a total 25 patients that were considered as good in quality. These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). 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). Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Annu Rev Med. 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. Surgical treatment of gynecomastia: Complications and outcomes. Plast Reconstr Surg. 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. 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). 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. background-position: right 65%; Narula HS, Carlson HE. 2019;166(5):934-939. A follow-up study of 105 women with breast cancer following reduction mammaplasty. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. border-width:0; Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. PLoS One. 2020 Sep 4 [Online ahead of print]. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. No data were provided on loss to follow-up. 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. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). 1995;61(11):1001-1005. 2006;9(2):109-114. Gland Surg. Howrigan P. Reduction and augmentation mammoplasty. 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. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. 2015;49(6):363-366. Second, it is the burden of the proponent of an intervention to provide reliable evidence of its effectiveness, not the burden of ones whoquestion the effectivenessan intervention to provide definitive proof of ineffectiveness. } 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. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. 1993;17(3):211-223. Computed tomography scan of adrenal glands to identify adrenal lesions. 1969;44(235):291-303. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note All patients underwent routine investigations to exclude secondary causes of gynecomastia. 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. Seitchik MW. 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. Breast reduction for symptomatic macromastia. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. 1998;101(2):361-364. Plast Reconstr Surg. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. ol.numberedList LI { These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Furthermore, the lack of an expected "dose-response" relationship between the amount of breast tissue removed and the magnitude of symptomatic relief in these studies raises questions about the validity of these studies and the effectiveness of breast reduction as a method of relieving shoulder and back pain. Plastic Reconstr Surg. Glatt BS, Sarwer DB, O'Hara DE, et al. cursor: pointer; If an insufficient amount of breast tissue is removed, the surgery is less likely to be successful in relieving pain and any related symptoms from excessive breast weight (e.g., excoriations, rash). list-style-type : square !important; Qu S, Zhang W, Li S, et al. In this study the National Surgical Quality Improvement Program data set was queried for the Current Procedural Terminology code 19318 from the years 2005 to 2010, with principal outcome measurements of wound complications, surgical site infections, and reoperations. margin-top: 38px; color:#eee; } This may lead to additional scarring and additional operating time. 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. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Plast Reconstr Surg. 1996;20(5):391-397. 2015;75(4):383-387. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. 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). Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Plastic Reconstruct Surg. What can I do if my insurance denies coverage for breast reduction? } Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. 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. Kalliainen LK; ASPS Health Policy Committee. and areola. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Will Aetna Insurance Cover my Breast Reduction? - RealSelf.com 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. 2017;139(6):1313-1322. } Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. No other operation-related complications were observed. Surgical treatment is indicated when medical treatments fail. cursor: pointer; 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. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Prostate Cancer Prostatic Dis. Aesthetic Plast Surg. A physician-supervised diet and exercise plan may be indicated in obese patients. Emiroglu M, Salimoglu S, Karaali C, et al. Plast Reconstr Surg. Miller AP, Zacher JB, Berggren RB, et al. font-size: 18px; Yao Y, Yang Y, Liu J, et al. The majority (87.7 %) of cases presented with accompanying mastalgia. 2014b;48(5):334-339. PDF Summary of Proposed Aetna Medicare Advantage Agreement 40 . z-index: 99; These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. 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. Type II gynecomastia is more generalized breast enlargement. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 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. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Other just require 500 grams no matter what your height and weight. Breast reduction outcome study. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. 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. li.bullet { However, these medications should be reserved for those with no decrease in breast size after 2 years.