Breast hypertrophy. } Does Aetna Cover Breast Reduction? | HelpAdvisor.com 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. Reduction mammaplasty: An outcome study. The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. 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). J Laparoendosc Adv Surg Tech A. #backTop { 2007;119(4):1159-1166. 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. 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. Ann Plast Surg. Tang CL, Brown MH, Levine R, et al. Aesthetic Plast Surg. Plastic Reconstr Surg. Rising Rates of Insurance Denial for Breast Reduction Surgery Plast Reconstr Surg. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. } 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). The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. .fixedHeaderWrap { Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare background-color: #cc0066; Collis N, McGuiness CM, Batchelor AG. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Principles of breast re-reduction: A reappraisal. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 01/04/2023 Little is known about the effect of surgical treatment on the psychological aspects of the disease. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. 2014;20(3):274-278. Washington, DC: ACOG; 2011:121-122. Breast Reduction Surgery | Johns Hopkins Medicine Mental health care professionals may be consulted to address psychological distress from gynecomastia. Reduction mammoplasty for asymptomatic members is considered cosmetic. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. 2 . 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. In: Townsend CM, Beuchamp RD, Evers BM, eds. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. No data were provided on loss to follow-up. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Level of Evidence = IV. Glatt BS, Sarwer DB, O'Hara DE, et al. In the case of reduction mammoplasty for relief of back, neck and shoulder pain, Aetna has considered this procedure medically necessary in women with excessively large breasts because it seems logical, even in the absence of firm clinical trial evidence, that this excessive weight would contribute to back and shoulder pain, and that removal of this excessive breast tissue would provide substantial pain relief, reductions in disability, and improvements in function. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. 2008;121(4):1092-1100. } Refer to the member's specific plan document for applicable coverage. A systematic search of the published literature was performed. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? 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. Breast J. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. 2017;35:157-161. Surgery. Nguyen JT, Wheatley MJ, Schnur PL, et al. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Policy. 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. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. 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). A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. 1998;26(1):61-65. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) ul.ur li{ Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. 18th ed. 1990;24(1):61-67. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 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. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. border-width:0; Gland Surg. (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. } 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. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. } 2007;356(5):479-485. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Safran T, Abi-Rafeh J, Alabdulkarim A, et al. 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). Qu S, Zhang W, Li S, et al. Although the BRAVO study nominally included a "control group", there was no comparison group of subjects selected from the same cohort, who were randomized or otherwise appropriately assigned to reduce bias, and treated with conservative management according to a protocol to ensure optimal conservative care.

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