font-size: 18px; Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. Nelson et al (2014b) separately conducted a population level analysis of the 2005-2011 NSQIP datasets, identifying patient who underwent reduction mammoplasty, to determine the impact of obesity on early complications after reduction mammoplasty. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. background-color: #cc0066; 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 average age was 24.7 years (range of 18 to 47 years). list-style-type: decimal; Ann Plast Surg. Does Health Insurance Cover Breast Reduction Surgery? - GoodRx skin should not be excised horizontally below the inframammary fold. 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. 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). 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. 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). 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. Ages ranged from 18 to 66 years. Raispis T, Zehring RD, Downey DL. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). 1998;101(2):361-364. Subjects were compared to age-matched norms from another study cohort. } Hoyos AE, Perez ME, Dominguez-Millan R, et al. Krieger LM, Lesavoy MA. Plast Reconstr Surg. Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. list-style-type: upper-roman; Plast Reconstr Surg. Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. margin-top: 38px; The following procedures are considered experimental and investigational because there is insufficient evidence of itseffectiveness or itseffectiveness has not been established: Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. Analysis was on an intention-to-treat basis. 2008;32(1):38-44. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Variations in pattern of pubertal changes in girls. Flancbaum L, Choban PS. American Society of Plastic Surgeons (ASPS). While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. 1998;49:215-234. A total of 81 patients were included in this study. 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. display: none; Surgical treatment is indicated when medical treatments fail. For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Gynecomastia may be drug-induced. 2014a;34(1):66-73. 2 . If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Another set of breast pump supplies if you get pregnant . If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). } Arch Dis Child. Plast Reconstr Surg. The mean age was 42.8 years (SD 19.5 years). Fischer S, Hirsch T, Hirche C, et al. Refer to the member's specific plan document for applicable coverage. 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. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . of . background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Treating providers are solely responsible for medical advice and treatment of members. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. padding-bottom: 4px; 2nd ed. li.bullet { 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: Araco A, Gravante G, Araco F, et al. Laituri CA, Garey CL, Ostlie DJ, et al. of the following criteria must be met: Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. Glatt BS, Sarwer DB, O'Hara DE, et al. Plast Reconstr Surg. Aesthetic Plast Surg. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. 1999;103(6):1674-1681. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. padding: 10px; 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. No statistically significant differences in the drainage, level of pain, size of open areas, clinical appearance, degree of scar pliability, or scar erythema were noted. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. 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. He Q, Zheng L, Zhuang D, et al. Bertin ML, Crowe J, Gordon SM. 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. Administration of Benefits and Transition Responsibilities Breast. 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. } Breast Concerns of Adolescents. 1999;103(6):1687-1690. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Guidelines for Adolescent Health Care. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline 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? 2021 Aug 11 [Online ahead of print]. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. 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. } There were only 2 studies of a total 25 patients that were considered as good in quality. 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. Major complications (1.6 %) included unilateral hematoma and localized infection. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Please check your insurance policy to see whether breast reduction is a covered procedure. 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. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Med Decis Making. Breast reduction outcome study. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. A follow-up study of 105 women with breast cancer following reduction mammaplasty. 1993;91(7):1270-1276. list-style-type: upper-alpha; Sugrue CM, McInerney N, Joyce CW, et al. J Plast Surg Hand Surg. 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.