Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Oxfordshire NHS Trust. 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. Gynecomastia is a very common concern of male adolescence. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. 2009;62(2):195-199. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. 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. } Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Brown DM, Young VL. J Plast Surg Hand Surg. You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. Fischer S, Hirsch T, Hirche C, et al. .newText { 2005;58(3):286-289. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Gynecomastia in patients with prostate cancer: Update on treatment options. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. (25 y/o female with a 38J bra size) according to aetna, I should more than qualify for a reduction as I have back, neck, shoulder pain, chest pain and pressure, arm numbness while laying on sides, etc. Plast Reconstr Surg. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. } Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. li.bullet { .headerBar { It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Narula HS, Carlson HE. 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.. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). 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. Setala L, Papp A, Joukainen S, et al. Collis N, McGuiness CM, Batchelor AG. Policy. Plast Reconstr Surg. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Ann Plast Surg. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. 2002;33:208-217. Glatt BS, Sarwer DB, O'Hara DE, et al. OL LI { These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. list-style-type: upper-alpha; width: 100%; In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. padding-bottom: 4px; Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. In other patients, excess skin and nipple and areola relocation are necessary. 2014a;34(3):409-416. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. With approval from the authors institutional ethics committee and written informed consent, a total of 22 patients with 33 abnormally hyperplastic breasts were enrolled at the First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. Treatment of adolescent gynecomastia. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. Grooving where the bra straps sit on the shoulder. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. right: 30px; 2010;45(3):650-654. Sugrue CM, McInerney N, Joyce CW, et al. 1998;101(2):361-364. Determinants of surgical site infection after breast surgery. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. 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. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. 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. text-decoration: line-through; Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Blomqvist L, Eriksson A, Brandberg Y. Plast Reconstr Surg. 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. 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. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. For individuals who received radiation treatment to the chest . The end-point was the complete resolution of gynecomastia. Plastic surgery for teenagers briefing paper. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. 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: The Mammotome procedure represented another novel therapeutic option for gynecomastia. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Kerrigan CL, Collins ED, Kim HM, et al. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne 2002;109(5):1556-1566. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Asian J Surg. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Plast Reconstr Surg. A cohort study of breast cancer risk in breast reduction patients. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Surgical treatment of primary gynecomastia in children and adolescents. 2019;8(4):431-440. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. 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. 2014;20(3):274-278. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. background-color: #663399; Links to various non-Aetna sites are provided for your convenience only. 1993;91(7):1270-1276. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Mayo Clin Proc. 1991;27(3):232-237. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Plast Reconstr Surg. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Tang CL, Brown MH, Levine R, et al. 2018;89(6):408-412. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. However, these medications should be reserved for those with no decrease in breast size after 2 years. 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.