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.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES 

American College of Obstetricians and Gynecologists. (2017, January). Committee opinion: Breast and labial surgery in adolescents. Retrieved February 28, 2018 from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Breast-and-Labial-Surgery-in-Adolescents.

American Society of Breast Surgeons Foundation. (2018). Breast reduction/reduction mammaplasty. Retrieved April 25, 2018 from https://breast360.org/en/topics/2015/01/01/breast-reduction-reduction-mammaplasty/.

American Society of Plastic Surgeons. (May, 2011). Evidence-based clinical practice guideline: reduction mammoplasty. Retrieved March 28, 2017 from https://www.plasticsurgery.org/for-medical-professionals/quality-and-registries/evidence-based-clinical-practice-guidelines.

BlueCross BlueShield Association. Evidence Positioning System. (3:2019). Reduction mammoplasty for breast-related symptoms (7.01.21). Retrieved August 16, 2019 from https://www.evidencepositioningsystem.com/.  (21 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. 

Cerrato, F., Webb, M., Rosen, H., Nuzzi, L., McCarty, E., DiVasta, A., et al. (2012).The impact of macromastia on adolescents: a cross-sectional study. Pediatrics, 130 (2). (Level 3 evidence)

CMS.gov: Centers for Medicare & Medicaid Services. Palmetto GBA. (2019, July). Cosmetic and reconstructive surgery (LCD ID L33428). Retrieved August 16, 2019 from http://www.cms.gov. 

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.

National Comprehensive Cancer Network. (2019, May). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Breast cancer screening and diagnosis. Retrieved August 16, 2019 from the National Comprehensive Cancer Network.

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.

Pike, C.M., Nuzzi, L.C, DiVasta, A.D., Greene, A.K., & Labow, B.I. (2015). Weight changes after reduction mammaplasty in adolescents. Journal of Adolescent Health, 57 (3), 277-281. Abstract retrieved April 25, 2018 from PubMed database.

Strong, B. & Hall-Findlay, E. (2014). How does volume of resection relate to symptom relief for reduction mammaplasty patients? Annals of Plastic Surgery. 2014 Apr 10. Epub ahead of print. Abstract retrieved June 7, 2016 from PubMed database.

ORIGINAL EFFECTIVE DATE:  1/1/1997

MOST RECENT REVIEW DATE:  9/26/2019

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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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