aetna breast reduction requirements

40 . The risks included infection, wound breakdown, scarring, and the need for re-operating. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. skin should not be excised horizontally below the inframammary fold. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). 2020 Sep 4 [Online ahead of print]. 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. display: block; bottom: 20px; Plastic Reconstr Surg. 1995;95(6):1029-1032. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Copyright Aetna Inc. All rights reserved. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Sugrue CM, McInerney N, Joyce CW, et al. border: none; 1990;24(1):61-67. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. #backTop:hover { Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Laituri CA, Garey CL, Ostlie DJ, et al. 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. Nguyen JT, Wheatley MJ, Schnur PL, et al. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Variations in pattern of pubertal changes in girls. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) 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. Plastic Reconstr Surg. Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . 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: Long-term functional results after reduction mammoplasty. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Gynaecomastia. Prostate Cancer Prostatic Dis. Aesthetic Plast Surg. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Gland Surg. 2001;76(5):503-510. To get insurance coverage, you'll probably need . 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. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Subjects were compared to age-matched norms from another study cohort. Prepubertal gynecomastia linked to lavender and tea tree oils. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. 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. Plast Reconstr Surg. J Pediatr Surg. Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? Karamanos E, Wei B, Siddiqui A, Rubinfeld I. American Society of Plastic Surgeons (ASPS). Yao Y, Yang Y, Liu J, 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). Principles of breast re-reduction: A reappraisal. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. The authors (Nguyen et al, 2004) argue, based primarily on the results of the ASPS-funded BRAVO study (described below), that (with a single exception) no objective criteria for breast reduction surgery are supportable, including criteria based upon the presence of particular signs or symptoms, requirements based upon breast size or the amount of breast tissue removed, any minimum age limitations, any limitation based upon maximum body weight, requirements for a trial of conservative therapy, or the exclusion of certain procedures (liposuction). Aesthetic Plast Surg. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Arlington Heights, IL: ASPS; March 9, 2002. Risk factors for complications following breast reduction: Results from a randomized control trial. color:#eee; Plast Reconstr Surg. Reduction mammaplasty provides long-term improvement in health status and quality of life. 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. Macromastia: all . The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. The average age was 24.7 years (range of 18 to 47 years). .newText { Am J Infect Control. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Surgical treatment of gynecomastia: Complications and outcomes. There were only 2 studies of a total 25 patients that were considered as good in quality. 2000;106(2):280-288. } This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 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. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. 2021 Aug 11 [Online ahead of print]. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Measuring health state preferences in women with breast hypertrophy. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. top: 0px; Management of gestational gigantomastia. 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. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the 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). Administration of Benefits and Transition Responsibilities Collis N, McGuiness CM, Batchelor AG. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . 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. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Evidence-based clinical practice guideline: Reduction mammaplasty. 2014;20(3):274-278. 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. 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. Blomqvist L, Eriksson A, Brandberg Y. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne 2018;24(6):1043-1045. 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. Breast cancer found at the time of breast reduction. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Sabistons Textbook of Surgery (Burns & Blackwell, 2008)states that breast size should be stable for one year: There is no set lower age limit but, for the adolescent with breast hypertrophy, reduction is deferred until the breasts have stopped growing and are stable in size for at least 12 months before surgery.. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. 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. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. 2010;45(3):650-654. display: none; 2019;8(4):431-440. }. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Recommended criteria for insurance coverage of reduction mammoplasty.

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