padding-right: 18px; Recommended criteria for insurance coverage of reduction mammoplasty. Disproportionately large breasts can cause both physical and emotional . Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. 1997;185(6):593-603. 2013;71(5):471-475. In the case of breast reduction, however, for insurance purposes, it . Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. No other operation-related complications were observed. Brown DM, Young VL. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. 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). Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Plast Reconstr Surg. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. background: #5e9732; Gynecomastia may be drug-induced. Wound drainage after plastic and reconstructive surgery of the breast. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Scand J Plast Reconstr Hand Surg. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. outline: none; This conclusion is based primarily upon the Breast Reduction Assessment of Value and Outcomes (BRAVO) study, which is described in several articles (Kerrigan et al, 2001; Kerrigan et al, 2002; Collins et al, 2002). Evidence-based clinical practice guideline: Reduction mammaplasty. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). A detailed physical examination, including testicular examination. A physician-supervised diet and exercise plan may be indicated in obese patients. The member has gigantomastia of pregnancy accompanied byany of the following complications, and delivery is not imminent: For medical necessity criteria for surgery to correct breast asymmetry, seeCPB 0185 - Breast Reconstructive Surgery. 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. Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. GP Notebook. Surgery. The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Reduction mammoplasty: Criteria for insurance coverage. Ann Plastic Surg. Gynecomastia in patients with prostate cancer: Update on treatment options. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Does Health Insurance Cover Breast Reduction Surgery? - GoodRx American Society of Plastic and Reconstructive Surgery (ASPRS). 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: Ann Plast Surg. margin-top: 38px; The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. The majority (87.7 %) of cases presented with accompanying mastalgia. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. of . The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. 18th ed. Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Breast Reduction | American Society of Plastic Surgeons list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. 2004;113(1):436-437. No new trials were identified for this first update. 1998;26(1):61-65. Plastic Reconstruct Surg. Reduction mammaplasty. Often times, insurance company will dictate how much breast tissue to be removed. In this study the National Surgical Quality Improvement Program data set was queried for the Current Procedural Terminology code 19318 from the years 2005 to 2010, with principal outcome measurements of wound complications, surgical site infections, and reoperations. 2016;20(3):256-260. Ann Plast Surg. 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. Townsend: Sabiston Textbook of Surgery. The average age was 24.7 years (range of 18 to 47 years). 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. Fagerlund A, Cormio L, Palangi L, et al. Links to various non-Aetna sites are provided for your convenience only. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. 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 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. 2007;119(4):1159-1166. 1. Gynecomastia has been classified into2 types. Copyright Aetna Inc. All rights reserved. Many men with breast enlargement are found to have pseudo-gynecomastia. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). J Plast Reconstr Aesthet Surg. 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 . A cohort study of breast cancer risk in breast reduction patients. 2021 Aug 11 [Online ahead of print]. (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. 2008;121(4):1092-1100. 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. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Policy Statement 6d: Aesthetic surgery procedures. Ann Plast Surg. Plastic Reconstruct Surg. cursor: pointer; 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. 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. 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. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. In: Townsend CM, Beuchamp RD, Evers BM, eds. 1996;20(5):391-397. The mean volume of tissue resected was 250 g (range of 22 to 758 g) from the right breast and 244 g (range of 15 to 705 g) from the left breast. My Experience of Having Breast Reduction Surgery - Health Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. CG-SURG-71 Reduction Mammaplasty - Anthem PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. This Clinical Policy Bulletin may be updated and therefore is subject to change. 1993;91(7):1270-1276. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Treating providers are solely responsible for medical advice and treatment of members. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Breast. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets.