Breast reduction with aetna approval

Background Reduction Mammaplasty Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: Anesthesia may be injected along with saline solution until the tissue is firm, and a suction cannula is used to extract fat from the breast. Reduction mammaplasty is among the most commonly performed cosmetic procedures in the United States.
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Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna

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Breast Reduction Surgery and Gynecomastia Surgery

Reduction mammoplasty is a cosmetic procedure to reduce the size of breasts in order to re-establish its functional capability for lactation, sensitivity and tissue viability. So, what you have to do is to prove to Aetna that your breast reduction surgery has non-cosmetic indications by meeting any of the three criteria below: You must prove that you suffered from headaches, pain in the neck, upper back or shoulders, ulceration and pain from your bra straps or painful kyphosis with X-ray. You need to present pictures to prove over-sized breasts.
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Aetna considers the body lift perforator flap technique for breast reconstruction experimental and investigational because there is insufficient evidence to support the effectiveness of this approach. Aetna considers the use of the following acellular dermal matrices medically necessary for breast reconstruction: Reduction or some cases augmentation mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Surgical Correction ; or Repair of breast asymmetry due to a medically necessary mastectomy or a medically necessary lumpectomy that results in a significant deformity. Aetna considers Biodesign Nipple Reconstruction Cylinder experimental and investigational becasue its effectiveness has not been established.
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