margin-top: 38px; J Plast Surg Hand Surg. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. The primary outcome was the difference in wound drainage over 24 hours. Yao Y, Yang Y, Liu J, et al. 2001;108(1):62-67. 1995;95(1):77-83. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. color: red Karamanos et al (2015) identified their study as the largest sample on breast reduction in the literature, in which age and surgeon specialty did not correlate with negative results. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. In other patients, excess skin and nipple and areola relocation are necessary. J Plast Reconstr Aesthet Surg. 2005;58(3):286-289. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. } 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. Policy Statement 6d: Aesthetic surgery procedures. High-risk lesions (atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], and lobular carcinoma in situ [LCIS]) were revealed in 37 (11.7 %), and cancer in 6 (1.9 %) patients. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . } Surgical management of gynecomastia--a 10-year analysis. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Breast hypertrophy. 1998;26(1):61-65. Surgery. 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. Ann Plast Surg. Plast Reconstr Surg. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. 2019;166(5):934-939. 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). Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. } Collins ED, Kerrigan CL, Kim M, et al. A population-level analysis of bilateral breast reduction: does age affect early complications? Plast Reconstr Surg. 1999;103(6):1674-1681. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. 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). Coding Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. Kerrigan CL, Collins ED, Striplin D, et al. Raispis T, Zehring RD, Downey DL. 18th ed. 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. Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years). J Laparoendosc Adv Surg Tech A. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Computed tomography scan of adrenal glands to identify adrenal lesions. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. OL LI { Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Blomqvist L, Eriksson A, Brandberg Y. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). 2005;55(3):227-231. 2001;107(5):1234-1240. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; The average age was 24.7 years (range of 18 to 47 years). 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. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. For many patients the psychological impact of the disease is substantial. 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. Br J Plast Surg. American Society of Plastic Surgeons (ASPS). Nguyen JT, Wheatley MJ, Schnur PL, et al. Plast Reconstr Surg. Mizgala CL, MacKenzie KM. 2003;111(2):688-694. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. 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. Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . Breast reduction for symptomatic macromastia. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. There were only 2 studies of a total 25 patients that were considered as good in quality. Plast Reconstr Surg. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. list-style-type: upper-alpha; Treating providers are solely responsible for medical advice and treatment of members. Long-term functional results after reduction mammoplasty. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Asian J Surg. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. and areola. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. # font-weight: bold; 2014b;48(5):334-339. Ann Plast Surg. Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. Copyright Aetna Inc. All rights reserved. 2000;106(2):280-288. 2015;75(4):370-375. It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. Philadelphia, PA: W.B. Arlington Heights, IL: ASPS; May 2011. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Management of gestational gigantomastia. In a review on Surgical treatment of primary gynecomastia in children and adolescents, Fischer et al (2014b) concluded that surgical correction of gynecomastia remains a purely elective intervention. World J Surg. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. In a systematic review, these investigators examined the role of radiotherapy in this context. Hello! Emiroglu M, Salimoglu S, Karaali C, et al. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Surgical treatment is indicated when medical treatments fail. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Miller AP, Zacher JB, Berggren RB, et al. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. 2017;35:157-161. Grooving where the bra straps sit on the shoulder. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 2015;75(4):383-387. Risk of bias was assessed independently by 2review authors. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain.