UM Guidelines
Mastectomy, Complete, with Insertion of Breast Prosthesis or Tissue Expander

Inpatient and Surgical Care (ISC)

BCBST last reviewed April 8, 2021*

Added to Clinical Indications:

   
Procedure may be indicated for 1 or more of the following:
 
 
  • Subcutaneous or total (simple) mastectomy indicated for...
    • [Patient or provider preference over partial mastectomy]*
    • ...
    • Risk-reduction mastectomy (RRM) indicated...
      • Significantly elevated risk of breast cancer as indicated by...
        • [Lobular carcinoma in situ]*
        • ...
   
Added to: Hospitalization - Goal Length of Stay
   
Goal Length Of Stay: Observation
 

References

American Cancer Society. (2020). Mastectomy. Retrieved July 21, 2020 from https://www.cancer.org/.

BlueCross BlueShield Association. Evidence Positioning System. (8:2019). Risk-reducing
mastectomy (7.01.09). Retrieved July 21, 2020 from https://www.evidencepositioningsytem.com/.
(21 articles and/or guidelines reviewed)

BlueCross BlueShield of Tennessee network physicians. January - April 2021.

National Cancer Institute. (2020). Surgery to reduce the risk of breast cancer. Retrieved July 21,
2020 from https://www.nih.gov/institutes-nih.

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