aetna breast reduction requirements

Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. J Plast Reconstr Aesthet Surg. Pediatr Surg Int. background-color: #cc0066; Special Clinical Concerns. The authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). Breast Pump & Breastfeeding Insurance Coverage & Resources | Aetna This Clinical Policy Bulletin may be updated and therefore is subject to change. list-style-type: decimal; Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass The average age was 24.7 years (range of 18 to 47 years). This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Scand J Plast Reconstr Hand Surg. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. 2016;20(3):256-260. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. color:#eee; Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Another set of breast pump supplies if you get pregnant . @media print { Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. Gynecomastia: A systematic review. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. OL OL LI { } 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. Type II gynecomastia is more generalized breast enlargement. list-style-type: decimal; Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Miller AP, Zacher JB, Berggren RB, et al. Aesthetic Plast Surg. 2nd ed. 1969;44(235):291-303. Aetna considers magnetic resonance imaging (MRI), with or without contrast materials, of the breast medically necessary for members who have had a recent (within the past year) conventional mammogram and/or breast sonogram, in any of the following circumstances where MRI of the breast may affect their clinical management:. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. background-position: right 65%; Priorities Forum Policy Statement. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). 1993;17(3):211-223. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Current concepts in gynaecomastia. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Plast Reconstr Surg. American Society of Plastic Surgeons (ASPS). PDF 0185 Breast Reconstructive Surgery (1) - Aetna Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. Collins ED, Kerrigan CL, Kim M, et al. hr.separator { Patient demographics, surgical technique, and outcomes were analyzed. A total of 15 articles met the inclusion criteria for review. Reduction mammaplasty: Defining medical necessity. 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. 2012;69(5):510-515. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. 2000;45(6):575-580. list-style-type: lower-roman; 2008;121(4):1092-1100. list-style-type : square !important; 18th ed. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Variations in pattern of pubertal changes in girls. 1998;101(2):361-364. 2002;33:208-217. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Management of gestational gigantomastia. Raispis T, Zehring RD, Downey DL. Breast and aesthetic surgery. 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. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. Plastic Reconstruct Surg. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Coding Statistical analysis was performed with student t-test and chi-square test. Breast cancer found at the time of breast reduction. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). Breast reduction for symptomatic macromastia. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Bertin ML, Crowe J, Gordon SM. text-decoration: underline; .strikeThrough { The health burden of breast hypertrophy. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. J Laparoendosc Adv Surg Tech A. Arlington Heights, IL: ASPS; March 9, 2002. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? 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. Reduction mammaplasty: An outcome study. Nguyen JT, Wheatley MJ, Schnur PL, et al. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. border-width:0; American Society of Plastic and Reconstructive Surgery (ASPRS). This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Level of Evidence = IV. Gonzalez FG, Walton RL, Shafer B, et al. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. A follow-up study of 105 women with breast cancer following reduction mammaplasty. Blomqvist L, Eriksson A, Brandberg Y. display: block; Schnur PL, Schnur DP, Petty PM, et al. of . Reduction mammoplasty for asymptomatic members is considered cosmetic. J Plast Reconstr Aesthet Surg. Oxford, UK: National Health Service (NHS); October 2008. /*margin-bottom: 43px;*/ 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. position: fixed; Well-designed trials are especially important in assessing pain management interventions to isolate the contribution of the intervention from placebo effects, the effects of other concurrently administered pain management interventions, and the natural history of the medical condition. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. right: 30px; 2003;111(2):688-694. Arlington Heights, IL: ASPS; 2011. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Plast Reconstr Surg. Pain/discomfort/ulceration from bra straps cutting into shoulders; Skin breakdown (severe soft tissue infection, tissue necrosis, ulceration hemorrhage) from overlying breast tissue; There is a reasonable likelihood that the member's symptoms are primarily due to macromastia; Reduction mammoplasty (also spelled as 'mammaplasty') is likely to result in improvement of the chronic pain; Pain symptoms persist as documented by the physician despite at least a 3-month trial of therapeutic measures such as: Analgesic/non-steroidal anti-inflammatory drugs (NSAIDs) interventions and/or muscle relaxants, Dermatologic therapy of ulcers, necrosis and refractory infection, Physical therapy/exercises/posturing maneuvers, Supportive devices (e.g., proper bra support, wide bra straps), Chiropractic care or osteopathic manipulative treatment. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or .newText { Level of Evidence = IV. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Please check your insurance policy to see whether breast reduction is a covered procedure. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. 2002;109(5):1556-1566. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. Chadbourne EB, Zhang S, Gordon MJ, et al. cursor: pointer; Breast J. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. } Kerrigan CL, Collins ED, Kim HM, et al. Breast. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Aesthet Surg J. Policy. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary.

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aetna breast reduction requirements