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With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an out-patient; however, this was not statistically significant (p = 0.07). The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Nguyen JT, Wheatley MJ, Schnur PL, et al. These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. Schnur PL, Hoehn JG, Ilstrup DM, et al. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. 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. Breast reduction surgery - Mayo Clinic color:#eee; Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Plastic Reconstr Surg. of . Surgical implications of obesity. In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). bottom: 20px; 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. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. PDF Clinical Policy Bulletin: Cosmetic Surgery - Aetna 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: Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). A non-standardized survey showed a very high satisfaction index. Fischer JP, Cleveland EC, Shang EK, et al. Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. Collins ED, Kerrigan CL, Kim M, et al. 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. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). My Experience of Having Breast Reduction Surgery - Health 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. 2001;108(1):62-67. } Women's Health and Cancer Rights Act of 1998. Bland KI, Copeland EM, eds. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. No author listed. Plast Reconstr Surg. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. 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. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Krieger LM, Lesavoy MA. 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. Often times, insurance company will dictate how much breast tissue to be removed. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Aesthet Surg J. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Horm Res Paediatr. 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. 2008;61(5):493-502. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Saunders Co.; 1991. padding-bottom: 4px; # color: white; Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. 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). PDF 0185 Breast Reconstructive Surgery (1) - Aetna They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. .fixedHeaderWrap { No other operation-related complications were observed. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Policy Statement 6d: Aesthetic surgery procedures. Aesthetic Plast Surg. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. 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. This may lead to additional scarring and additional operating time. Reduction mammaplasty: Defining medical necessity. 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? 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. 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. Reduction mammaplasty provides long-term improvement in health status and quality of life. 1990;24(1):61-67. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. In the case of reduction mammoplasty for relief of back, neck and shoulder pain, Aetna has considered this procedure medically necessary in women with excessively large breasts because it seems logical, even in the absence of firm clinical trial evidence, that this excessive weight would contribute to back and shoulder pain, and that removal of this excessive breast tissue would provide substantial pain relief, reductions in disability, and improvements in function.