aetna breast reduction requirements

The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. 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). Current concepts in gynaecomastia. 2002;109(5):1556-1566. Level of Evidence = III. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Townsend: Sabiston Textbook of Surgery. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Plastic Reconstr Surg. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. American Society of Plastic Surgeons (ASPS). The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Ann Plast Surg. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Breast Reduction Surgery | Johns Hopkins Medicine Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Ann Plast Surg. 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]). Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). 1993;91(7):1270-1276. Plast Reconstr Surg. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Level of Evidence = IV. How to Get Your Breast Reduction Covered By Insurance - RealSelf News The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Aetna considers breast reconstructive surgery to correct Araco A, Gravante G, Araco F, et al. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. 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. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? No necrosis, systemic infection, or muscle paralysis was reported. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Policy Statement 6d: Aesthetic surgery procedures. 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. Patient demographics, surgical technique, and outcomes were analyzed. Rising Rates of Insurance Denial for Breast Reduction Surgery The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. color: red!important; Schnur et al (1991) reported on a sliding scale assigns a weight of breast tissue to be removed based on body weight and surface area. 1998;26(1):61-65. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. 2012;69(5):510-515. 1999;103(6):1682-1686. list-style-type: decimal; 1999;103(6):1674-1681. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Socioeconomic Committee Position Paper. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Gonzalez FG, Walton RL, Shafer B, et al. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. GP Notebook. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline 2021;74(11):3128-3140. Is breast reduction covered by health insurance? | ASPS 2008;53(3):255-261. 2006;118(4):840-848. 2014b;30(6):641-647. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. J Plast Surg Hand Surg. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Leclere FM, Spies M, Gohritz A, Vogt PM. 2009;7(2):114-119. Plast Reconstr Surg. 2010;125(5):1301-1308. 2005;58(3):286-289. Fagerlund A, Cormio L, Palangi L, et al. The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. 2021;147(5):1072-1083. --> Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Does Aetna Cover Breast Reduction? | HelpAdvisor.com Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. 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. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Fischer S, Hirsch T, Hirche C, et al. Philadelphia, PA: W.B. 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. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. 01/04/2023 Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna Follow-up ranged from 2 months to 3 years. This will be computed based on your body area. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Breast asymmetries: A brief review and our experience. Gynecomastia in patients with prostate cancer: Update on treatment options. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Surgical implications of obesity. The average age was 24.7 years (range of 18 to 47 years). If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Plast Reconstr Surg. Washington, DC: ACOG; 2011:121-122. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Ann Plast Surg. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). .fixedHeaderWrap { Marshall WA, Tanner JM. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. 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. A total of 182 thirty-day postoperative surgical complications were documented, but stratifying patients into 2 age groups did not reveal an association between age and any surgical complication (P = .26). The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. 1999;103(6):1687-1690. 2000;106(5):991-997. 1998;49:215-234. 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. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Subjects were compared to age-matched norms from another study cohort. 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. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Reduction mammaplasty: An outcome study. The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. Chadbourne EB, Zhang S, Gordon MJ, et al. 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). Plast Reconstr Surg. 2 . Other just require 500 grams no matter what your height and weight. Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) ul.ur li{ 2018;89(6):408-412. OL OL OL OL LI { Major complications (1.6 %) included unilateral hematoma and localized infection. Ages ranged from 18 to 66 years. Plast Reconstr Surg. OL OL LI { Hello! list-style-type: upper-alpha; 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. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna Qu S, Zhang W, Li S, et al. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Arlington Heights, IL: ASPS; March 9, 2002. In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. In other patients, excess skin and nipple and areola relocation are necessary. 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. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. J Plast Surg Hand Surg. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. 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). Plast Reconstr Surg. 1995;34(2):113-116. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Reduction mammaplasty provides long-term improvement in health status and quality of life. Oxford, UK: National Health Service (NHS); October 2008. Seitchik MW. Saunders Co.; 1991. Flancbaum L, Choban PS. Principles of breast re-reduction: A reappraisal. Anesthesia may be injected along with saline solution until the tissue is firm, and a suction cannula is used to extract fat from the breast. Br J Plast Surg. .newText { Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. @media print { Cochrane Database Syst Rev. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. background-color: #663399; The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 2014b;48(5):334-339. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies.



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