aetna breast reduction requirements

For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Brown MH, Weinberg M, Chong N, et al. 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:. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna 2015;(10):CD007258. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. border-width:0; Breast cancer found at the time of breast reduction. 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. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. 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. However, these medications should be reserved for those with no decrease in breast size after 2 years. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. 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. outline: none; While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. 2006;118(4):840-848. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. 2013;71(5):471-475. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Endocrinol Metab Clin North Am. Reduction mammaplasty: Defining medical necessity. Gynaecomastia. } list-style-type : square !important; 2010;45(3):650-654. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. 2001;107(5):1234-1240. 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. Gynecomastia may be drug-induced. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the of the following criteria must be met: Collins ED, Kerrigan CL, Kim M, et al. Breast J. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Often times, insurance company will dictate how much breast tissue to be removed. cursor: pointer; Policy. 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. } Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass And if you are in Canada the surgeon decides. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. 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 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. 2021;74(11):3128-3140. 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). 2014a;34(1):66-73. Howrigan P. Reduction and augmentation mammoplasty. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. My Experience of Having Breast Reduction Surgery - Health Level of Evidence = IV. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Level of Evidence = IV. 2008;61(5):493-502. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. Plastic Reconstruct Surg. Plast Reconstr Surg. This will be computed based on your body area. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. The Mammotome procedure represented another novel therapeutic option for gynecomastia. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. li.bullet { The majority (87.7 %) of cases presented with accompanying mastalgia. A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio). 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. Ann Chir Plast Esthet. PDF A look at new changes coming to E&M and breast coding in 2021 The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Burdette TE, Kerrigan CL, Homa KA. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). 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). Disproportionately large breasts can cause both physical and emotional . Aetna considers breast reconstructive surgery to correct Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. } Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Risk factors for complications following breast reduction: Results from a randomized control trial. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Breast and aesthetic surgery. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Obesity and complications in breast reduction surgery: Are restrictions justified? 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). 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. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Am J Infect Control. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. } Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Gynecomastia: Evolving paradigm of management and comparison of techniques. A systematic search of the published literature was performed. 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 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. Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. Surgical treatment of primary gynecomastia in children and adolescents. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. When seeking preauthorization for a breast reduction, your goal is generally twofold. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). # color: white; Prostate Cancer Prostatic Dis. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. This may lead to additional scarring and additional operating time. They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. 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. A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. Reduction mammoplasty: Cosmetic or reconstructive procedure? 2009;7(2):114-119. You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. 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. 1969;44(235):291-303. ol.numberedList LI { Socioeconomic Committee Position Paper. 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. margin-top: 38px; Emiroglu M, Salimoglu S, Karaali C, et al. 2002;109(5):1556-1566. 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. 1996;20(5):391-397. 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. Breast. The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Setala L, Papp A, Joukainen S, et al. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Blomqvist L, Eriksson A, Brandberg Y. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. No other operation-related complications were observed. 1993;91(7):1270-1276. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. cursor: pointer; Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. American Society of Plastic Surgeons (ASPS). 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). These preliminary findings need to be validated by well-designed studies. 1995;95(1):77-83. Plast Reconstr Surg. 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. Does Health Insurance Cover Breast Reduction Surgery? - GoodRx Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. display: none; padding: 10px; 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. Nguyen JT, Wheatley MJ, Schnur PL, et al. Plast Reconstr Surg. Townsend: Sabiston Textbook of Surgery. Fagerlund A, Cormio L, Palangi L, et al. list-style-type: lower-roman; Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. 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). Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Plast Reconstr Surg. 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 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. Qu S, Zhang W, Li S, et al. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare Policy Statement 6d: Aesthetic surgery procedures. Does Aetna Cover Breast Reduction? | HelpAdvisor.com Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. OL OL LI { 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. Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. padding-bottom: 4px; Oxford, UK: National Health Service (NHS); October 2008. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Plastic Reconstr Surg. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. 01/04/2023 A detailed physical examination, including testicular examination. Surg Laparosc Endosc Percutan Tech. Plast Reconstr Surg. Measuring health state preferences in women with breast hypertrophy. 2017;35:157-161. Laituri CA, Garey CL, Ostlie DJ, et al. Plast Reconstr Surg. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? bottom: 20px; After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Study subjects included 3538 patients with an average age of 43 years and body mass index of 31.6 kg/m(2) and most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes.The incidence of overall surgical complications was 5.1% and the incidence of major surgical complications was 2.1%. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Plast Reconstr Surg. Well-designed clinical trials provide reliable information about the effectiveness of an intervention, and provide valid information about the characteristics of patients who would benefit from that intervention. right: 30px; 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. J Pediatr Surg. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. J Plast Surg Hand Surg. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Women's Health and Cancer Rights Act of 1998. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). N Engl J Med. Saunders Co.; 1991. Breast reduction outcome study. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. 2002;33:208-217. 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. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline A total of 81 patients were included in this study. Computed tomography scan of adrenal glands to identify adrenal lesions. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. The risks included infection, wound breakdown, scarring, and the need for re-operating. Reduction mammoplasty improves symptoms of macromastia. There were 18 out of 415 studies eligible to review. 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. Aesthetic Plast Surg. Gynecomastia. Scand J Plast Reconstr Hand Surg. Quality of life after breast reduction. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). Aesthet Plastic Surg. PDF Procedures, programs and drugs you must precertify - AmeriBen Second, it is the burden of the proponent of an intervention to provide reliable evidence of its effectiveness, not the burden of ones whoquestion the effectivenessan intervention to provide definitive proof of ineffectiveness. Arch Dis Child. Kerrigan CL, Collins ED, Kim HM, et al. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. border-radius: 4px; Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. 2007;356(5):479-485. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. 1995;34(2):113-116. See Appendix for Table 1. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. 2017;139(6):1313-1322. PDF Gender Dysphoria Treatment - Cigna Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). Ann Plastic Surg. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. 2015;49(6):363-366. No author listed. 2009;19(3):e85-e90. No necrosis, systemic infection, or muscle paralysis was reported. color: white; of . Tang CL, Brown MH, Levine R, et al. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. 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. There were only 2 studies of a total 25 patients that were considered as good in quality. Collis N, McGuiness CM, Batchelor AG. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna

La Finest Sydney Burnett Car, John Gaines Basketball, Hyundai Head Bolt Torque Specs, Non Examples Of Internationalization, Articles A