} The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. } 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. Hoyos AE, Perez ME, Dominguez-Millan R, et al. Magnetic Resonance Imaging (MRI) of the Breast - Aetna Plast Reconstr Surg. Gynecomastia in patients with prostate cancer: A systematic review. The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. } World J Surg. Endocrinol Metab Clin North Am. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. In other patients, excess skin and nipple and areola relocation are necessary. 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. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. list-style-type: lower-alpha; Plast Reconstr Surg. 2021 Aug 11 [Online ahead of print]. For many patients the psychological impact of the disease is substantial. 1993;17(3):211-223. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Risk factors for complications following breast reduction: Results from a randomized control trial. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. 2015;49(6):363-366. Reduction mammaplasty: Defining medical necessity. 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. How to Get Your Breast Reduction Covered By Insurance - RealSelf News 2007;356(5):479-485. Emiroglu M, Salimoglu S, Karaali C, et al. .arrowPurpleSmall, a:hover.arrowPurpleSmall { Plast Reconstr Surg. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . OL LI { Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an out-patient; however, this was not statistically significant (p = 0.07). Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. Med Decis Making. 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). Gynaecomastia. position: fixed; If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. border-width:0; Krieger LM, Lesavoy MA. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review outline: none; It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. 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. OL OL LI { There were only 2 studies of a total 25 patients that were considered as good in quality. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. text-decoration: line-through; Asian J Surg. 1969;44(235):291-303. Coding It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Management of gestational gigantomastia. 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). These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Chadbourne EB, Zhang S, Gordon MJ, et al. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. GP Notebook. Major complications (1.6 %) included unilateral hematoma and localized infection. 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. 2016;20(3):256-260. Tang CL, Brown MH, Levine R, et al. 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. Burdette TE, Kerrigan CL, Homa KA. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). 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. #closethis { Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). 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. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Level of Evidence = IV. Hello! Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. 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. padding-right: 18px; There were no restrictions on the basis of date or language of publication. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Handschin AE, Bietry D, Hsler R, et al. Reduction mammoplasty improves symptoms of macromastia. Breast reduction surgery - Mayo Clinic 2008;121(4):1092-1100. Computed tomography scan of adrenal glands to identify adrenal lesions. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? 2006;118(4):840-848. Breast Reduction | American Society of Plastic Surgeons Plast Reconstr Surg. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Ann Chir Plast Esthet. } hr.separator { Plast Reconstr Surg. J Am Coll Surg. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery.