BlueCross BlueShield of Tennessee Medical Policy Manual

Reduction Mammaplasty (Non-Cancerous) (Reduction Mammoplasty)

DESCRIPTION

Reduction mammoplasty is a surgical procedure designed to remove a variable proportion of breast tissue.  Macromastia, or gigantomastia, is a condition that describes breast hyperplasia or hypertrophy.

Macromastia may result in clinical symptoms such as shoulder, neck, or back pain, or recurrent intertrigo in the mammary folds. In addition, macromastia may be associated with psychosocial or emotional disturbances related to the large breast size. The available evidence from randomized controlled and prospective studies indicates that reduction mammoplasty is effective at decreasing breast-related symptoms such as pain and discomfort.  There is also evidence that functional limitations related to breast hypertrophy are improved following reduction mammoplasty.  Therefore, the available evidence for reduction mammoplasty is sufficient to demonstrate improvements in net health outcome.

POLICY

See also:

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES 

American Society of Plastic Surgeons. (May, 2011). Evidence-based clinical practice guideline: reduction mammoplasty. Retrieved March 28, 2017 from  www.plasticsurgery.org

BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2017). Reduction mammoplasty for breast-related symptoms (7.01.21). Retrieved March 28, 2017 from BlueWeb. (23 articles and/or guidelines reviewed)

British Association of Plastic Reconstructive and Aesthetic Surgeons. (May, 2014). Commissioning guide: breast reduction surgery. Retrieved May 18, 2015 from http://www.rcseng.ac.uk. 

Cahaba Government Benefit Admonistrators (2015, October). Local Coverage Determination LCD for surgery: reduction mammaplasty (L35554). Retrieved June 7, 2016 from https://www.cms.gov.

Cerrato, F., Webb, M., Rosen, H., Nuzzi, L., McCarty, E., DiVasta, A., et. al., (2012, August) The impact of macromastia on adolescents: a cross-sectional study. Pediatrics. Vol. 130, No. 2. (Level 3 evidence)

Chun, Y.S., Schartz, M.A., Gu, X., Lipsitz, S.R., & Carty, M.J. (2012). Body mass index as a predictor of postoperative complications in reduction mammaplasty. Plastic and Reconstructive Surgery, 129 (2), 228-233. Abstract retrieved July 24, 2015 from PubMed database.

Desouki, M. (2015, November) Reduction mammoplasty is beneficial in women with and without history of breast Cancer. Women’s Health. (2015) 11(4), 419–422. (Level 3 evidence)

Gonzalez, M.A., Glickman, L.T., Aladegbami, B., & Simpson, R.L. (2012). Quality of life after breast reduction surgery: a 10-year retrospective analysis using the breast Q questionnaire: does breast size matter? Annals of Plastic Surgery, 69 (4), 361-363. Abstract retrieved May 20, 2015 from PubMed database.

Gust, M.J., Smetona, J.T., Persing, J.S., Hanwright, P.J., Fine, N.A., & Kim, J.Y. (2013). The impact of body mass index on reduction mammoplasty: a multicenter analysis of 2492 patients. Aesthetic Surgery Journal, 33 (8), 1140-1147. Abstract retrieved May 20, 2015 from PubMed database.

Manahan, M.A., Buretta, K.J., Chang, D., Mithani, S.K., Mallalieu, J., & Shermak, M.A. (2015). An outcomes analysis of 2142 breast reduction procedures. Annals of Plastic Surgery, 74 (3), 289-292. Abstract retrieved June 3, 2015 from PubMed database.

Nelson, J.A., Fischer, J.P., Chung, C.U., West, A., Tuggle, C.T., et al. (2014). Obesity and early complications following reduction mammaplasty: an analysis of 4545 patients from the 2005-2011 NSQIP datasets. Journal of Plastic Surgery and Hand Surgery, 48 (5), 334-339. Abstract retrieved July 24, 2015 from PubMed database.

Singh, K.A. & Losken, A. (2012). Additional benefits of reduction mammoplasty: a systemic review of the literature. Plastic and Reconstructive Surgery, 129 (3), 562-570. Abstract retrieved June 3, 2015 from PubMed database.

Strong, B. and Hall-Findlay, E. (2014, April) How does volume of resection relate to symptom relief for reduction mammaplasty patients? Annals of Plastic Surgery. Epub ahead of print. Retrieved June 7, 2016 from PubMed database.

ORIGINAL EFFECTIVE DATE:  1/1/1997

MOST RECENT REVIEW DATE:  5/11/2017

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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