2000;106(5):991-997. 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. The Mammotome procedure represented another novel therapeutic option for gynecomastia. 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). Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. #backTop { J Pediatr Surg. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. J Plast Reconstr Aesthet Surg. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). 2015;10(8):e0136094. 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. 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). Oxford, UK: National Health Service (NHS); October 2008. The authors concluded that breast re-reduction can be performed safely and predictably, even when the previous technique is not known; and 4 key principles were developed: Language services can be provided by calling the number on your member ID card. 18th ed. list-style-type: decimal; 2008;121(4):1092-1100. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Seitchik MW. border-radius: 4px; }. Collins ED, Kerrigan CL, Kim M, et al. position: fixed; Aesthetic Plast Surg. color: #FFF; OL OL LI { Endocrinol Metab Clin North Am. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). 1994;21(3):539-543. 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. cursor: pointer; 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. Major complications (1.6 %) included unilateral hematoma and localized infection. A total of 15 articles met the inclusion criteria for review. The authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. 2015;(10):CD007258. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Magnetic Resonance Imaging (MRI) of the Breast - Aetna color: blue!important; 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. Socioeconomic Committee Position Paper. Tang CL, Brown MH, Levine R, et al. right: 30px; .fixedHeaderWrap { No necrosis, systemic infection, or muscle paralysis was reported. Pediatr Surg Int. There were no restrictions on the basis of date or language of publication. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. 2012;69(5):510-515. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Another set of breast pump supplies if you get pregnant . Aetna considers magnetic resonance imaging (MRI), with or without contrast materials, of the breast medically necessary for members who have had a recent (within the past year) conventional mammogram and/or breast sonogram, in any of the following circumstances where MRI of the breast may affect their clinical management:. hr.separator { They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. color:#eee; The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). 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). Howrigan P. Reduction and augmentation mammoplasty. Fagerlund A, Cormio L, Palangi L, et al. Ann Plast Surg. How to Get Your Breast Reduction Covered By Insurance - RealSelf News Arch Dis Child. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline Plast Reconstr Surg. 1991;27(3):232-237. 1969;44(235):291-303. 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. 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. Reduction mammaplasty: An outcome study. 2005;58(3):286-289. Surgical management of gynecomastia--a 10-year analysis. Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. border-width:0; 2018;89(6):408-412. Brown MH, Weinberg M, Chong N, et al. The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. 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. Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. 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. Petty PM, Solomon M, Buchel EW, Tran NV. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. The average age was 24.7 years (range of 18 to 47 years). 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. Plastic Reconstr Surg. First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. J Am Coll Surg. Tang CL, Brown MH, Levine R, et al. Aetna Coverage Denial - 2nd Appeal (They said I'm overweight) 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. Statistical analysis was performed with student t-test and chi-square test. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Townsend: Sabiston Textbook of Surgery. } The end-point was the complete resolution of gynecomastia. Also, there was no correlation between PR expression and 2D: 4D. The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. 2007;119(4):1159-1166. /* aetna.com standards styles for templates */ } 2021 Aug 11 [Online ahead of print]. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. } Nguyen JT, Wheatley MJ, Schnur PL, et al. Plast Reconstr Surg. Aetna considers breast reconstructive surgery to correct PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna 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. 2002;109(5):1556-1566. The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. } list-style-type: upper-roman; Macromastia: all . American Society of Plastic Surgeons (ASPS). For many patients the psychological impact of the disease is substantial. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Surgical implications of obesity. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Plast Reconstr Surg. 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.
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