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Apr 21

aetna breast reduction requirements

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. The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Is breast reduction covered by health insurance? | ASPS Brown MH, Weinberg M, Chong N, et al. A systematic search of the published literature was performed. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Breast and aesthetic surgery. No author listed. Lonie S, Sachs R, Shen A, et al. list-style-type: lower-roman; A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. 2014b;48(5):334-339. 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. Can objective predictors for operative success be identified? While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Am Surg. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. } 2 . 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. display: none; Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. } Secondary outcomes included subjective as well as objective assessments of pain and wound healing. 2006;9(2):109-114. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Breast J. N Engl J Med. Gynecomastia may be drug-induced. However, these medications should be reserved for those with no decrease in breast size after 2 years. Plast Reconstr Surg. 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). 2019;166(5):934-939. Surgery. Prostate Cancer Prostatic Dis. 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. Oxfordshire NHS Trust. Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Plast Reconstr Surg. The mean age was 42.8 years (SD 19.5 years). position: fixed; Ann Plast Surg. OL LI { The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 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. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. All RCTs that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. J Laparoendosc Adv Surg Tech A. 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. 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. right: 30px; Reduction mammoplasty improves symptoms of macromastia. 1969;44(235):291-303. 1998;101(2):361-364. list-style-type : square !important; Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. #backTop { } The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Grooving where the bra straps sit on the shoulder. Mizgala CL, MacKenzie KM. A total of 90 patients underwent breast re-reduction surgery. 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? Collins ED, Kerrigan CL, Kim M, et al. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. } Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. OL OL LI { Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Aetna considers breast reconstructive surgery to correct 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. J Pediatr Surg. Saunders Co.; 1991. Arlington Heights, IL: ASPS; May 2011. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Plast Reconstr Surg. 2007;356(5):479-485. GP Notebook. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Last Review01/04/2023. For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. Asian J Surg. color: blue He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Khan SM, Smeulders MJ, Van der Horst CM. Abnormalities in Adolescent Breast Development. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. Treating providers are solely responsible for medical advice and treatment of members. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. American Society of Plastic Surgeons (ASPS). li.bullet { A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. 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. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. 2003;111(2):688-694. 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). Karamanos E, Wei B, Siddiqui A, Rubinfeld I. ASPS Recommended Coverage Criteria for Third Party Payors. 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. A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammoplasty regarding physical symptoms and body image. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. No data were provided on loss to follow-up. Socioeconomic Committee Position Paper. 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).

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aetna breast reduction requirements