DOCSLIB.ORG

Breast Reduction and Mastopexy for Repair of Asymmetry After Breast Conservation Therapy: Lessons Learned

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Breast Reduction and Mastopexy for Repair of Asymmetry After Breast Conservation Therapy: Lessons Learned Aesth Plast Surg (2019) 43:600–607 https://doi.org/10.1007/s00266-019-01338-0 ORIGINAL ARTICLE BREAST SURGERY Breast Reduction and Mastopexy for Repair of Asymmetry After Breast Conservation Therapy: Lessons Learned 1 1 1 1 1 Yoav Barnea • Gal Bracha • Ehud Arad • Eyal Gur • Amir Inbal Received: 17 December 2018 / Accepted: 11 February 2019 / Published online: 25 February 2019 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019 Abstract occurrence of complications and patients’ demographics, Background Breast conservation therapy (BCT) can cause tumor type, tumor location, and breast tissue resection breast distortion and asymmetry. Repair of this asymmetry (p [ 0.05). by means of breast reduction or mastopexy procedures can Conclusion Only two of our 25 patients had major com- be challenging and harbor considerably high rates of plications following breast reduction and mastopexy for the complications. repair of asymmetry post-BCT. Following our four-step Methods In this retrospective study, we describe our protocol was instrumental in leading to the successful experience in repairing post-BCT breast asymmetry by performance of these procedures. performing breast reduction or mastopexy. The surgical Level of Evidence IV This journal requires that authors protocol we followed consisted of stringent patient selec- assign a level of evidence to each article. For a full tion, thorough surgical planning, basic surgical refine- description of these Evidence-Based Medicine ratings, ments, and patient education for enhancing the likelihood please refer to the Table of Contents or the online of achieving a good outcome with minimal surgical Instructions to Authors www.springer.com/00266. complications. Results Our search of the departmental database identified Keywords Breast conservation therapy Á Breast reduction Á 25 patients with breast asymmetry who had undergone Mastopexy Á Radiated breast breast reduction or mastopexy between 2009 and 2017. Corrective surgery was performed 4 years on average after the completion of radiotherapy, and those patients included Introduction eleven who had undergone breast reduction and fourteen who had undergone mastopexy on the radiated side. Two Breast conservation therapy (BCT) involves tumor resec- patients (8%) had major complications that required further tion with clear margins followed by radiation therapy, and surgery (major fat necrosis, wound infection, and breast it is the current standard of care for isolated breast cancer. deformation), and five patients (20%) had minor compli- It has been shown to attain local oncological control with cations (infection, minor fat necrosis, wound dehiscence, survival rates similar to those of mastectomy [1–3]. BCT and nipple congestion). All complications developed on the allows sparing of the remaining breast tissue, thus leading radiated breast. There was no correlation between the to almost normal breast sensation and improved quality of life [4–8]. However, the combination of wide tumor resection and postoperative radiation-induced fibrosis may & Yoav Barnea [email protected] cause significant breast deformity, asymmetry, fat necrosis, and nipple–areolar complex (NAC) malposition [9, 10]. 1 Plastic and Reconstructive Breast Surgery Unit, Department Improving the breast symmetry in these cases is surgically of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky challenging due to the radiation-induced injury to the Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St., 6423906 affected breast. Surgical options include local tissue rear- Tel Aviv, Israel rangement or tissue displacement by means of flaps of 123 Aesth Plast Surg (2019) 43:600–607 601 tissue and skin to reconstruct the volume, shape, and Table 1 Patient demographics (n = 25) envelope of the affected breast [4, 11–15]. Age, mean (range) 60.8 (42–74) Patients who have breast ptosis and hypertrophy with BMI, mean (range) 27.7 (21–35) significant asymmetry after undergoing BCT are potential Comorbidities n (%) candidates for local tissue rearrangement in the form of Hypertension 7 (28%) breast reduction or mastopexy, together with adjustment of Hyperlipidemia 6 (24%) the contralateral healthy breast. This procedure can Diabetes mellitus 4 (16%) improve the cosmetic result and the patient’s quality of life. Hypothyroidism 3 (12%) Nevertheless, breast reduction procedures in a previously Hyperthyroidism 3 (12%) operated and radiated breast raise concerns about wound Asthma 2 (8%) healing complications, infection, NAC necrosis, fat necrosis, prolonged edema, and further breast deformation Anemia 1 (4%) [16], leading many plastic surgeons to reject these high-risk IHD 1 (4%) cases. There has been an ongoing search for surgical Other malignancy 1 (4%) modifications and refinements to achieve a good outcome Smokers 5 (20%) with minimal complications for these challenging cases. Previous breast surgery 2 (8%) Recent studies have demonstrated acceptable complica- BRCA gene mutation 0 (0%) tion rates for breast reductions in post-radiated patients BSO 0 (0%) when refined surgical techniques are used and compre- BMI body mass index; IHD ischemic heart disease; BSO bilateral hensive patient education is provided [17–22]. Surgical salpingo-oophorectomy refinements described in the literature include avoiding skin undermining [17–22], planning a wide NAC pedicle [18–20], and dissecting thick skin flaps [18–20, 22]. A current smokers were required to stop smoking at least major limitation of these studies is the small number of 1 month prior to surgery. The postoperative outcome and patients in each series [17–22]. In the current retrospective complications are summarized in Table 3. study, we report the largest number of patients who All the study patients were approved for surgery and underwent breast reduction and mastopexy in previously followed up by the multidisciplinary breast team, including irradiated BCT deformities. We present our surgical mandatory recent breast imaging before surgery (breast approach for these cases, from patient selection and edu- ultrasound, mammography and/or magnetic resonance cation to planning and refinements in the surgical tech- imaging). Surgery was scheduled at least 6 months after nique—all of which are based on lessons learned. We completing the radiation therapy. The surgery planned for believe that these cumulative data can serve to reduce the patients with significant skin damage or substantial fat complication rate and ensure a better outcome in these necrosis following radiation therapy was postponed in the challenging high-risk cases. anticipation of future improvement and softening of the breast tissue. All patients signed an informed consent, after the limitations of surgery in a radiated field, including Patients and Methods postoperative breast asymmetry and complications, had been clearly explained in detail. We reviewed all consecutive patients who underwent breast reduction and mastopexy for asymmetry repair after Surgical Technique breast conservation therapy in our department between 2009 and 2017. Patients with previous breast reduction, Preoperative marking was done after photographing the bilateral tumors, or loss to follow-up were excluded from chest with the patient standing. Each breast was assessed the study. All surgeries were performed in our institution for volume, shape, and nipple position in order to strategize and in a private clinic by the two senior authors (YB and the reduction technique and volume. The radiated breast AI) who used the same surgical approach. The study was was further assessed for skin and soft tissue quality and the approved by the institutional review board (IRB). location of the previous scar and tissue deficit. The new The patients’ demographics, comorbidities, smoking nipple position was drawn on the central meridian of the history, oncological staging, treatment, radiation therapy, breast, typically 1–2 cm below the projected inframam- and surgical data were retrospectively collected from our mary fold (IMF). Nipple position of the radiated breast was database (Tables 1, 2). Removal of C 100 g of breast drawn 1 cm below that of the healthy breast, because of tissue was defined as breast reduction, while removal of \ 100 g was defined as mastopexy. Patients who were 123 602 Aesth Plast Surg (2019) 43:600–607 Table 2 Oncologic data (n = 25) anticipated sagging of the healthy breast which has more Characteristics Number (%) skin laxity compared to the radiated breast. The skin resection was drawn in a dome-mosque con- Tumor type figuration, with the vertical limbs marked by displacement DCIS 3 (12%) of the breast medially and laterally along the breast IDC 16 (64%) meridian (the Lassus maneuver). Skin resection marking LCIS 1 (4%) was more conservative on the radiated breast, with roughly ILC 4 (16%) 1 cm less for each limb. In cases of previous lower-pole Unknown 1 (4%) lumpectomy and scars, the skin resection was even more Lymph node surgery conservative, and the skin was only de-epithelialized and Sentinel lymph node biopsy 13 (52%) sutured in a vest-over-pants fashion, to add volume to the Axillary lymph node dissection 12 (48%) lower pole in selected cases. The skin resection marking Chemotherapy was adjusted to incorporate the previous lower-pole scar, Neoadjuvant 2 (8%) even if the vertical scar turned out oblique, off the meridian Neoadjuvant ? biologic 3 (12%) line. Adjuvant 3 (12%) The vascular
Load more

Recommended publications
  • Breast Reduction with Dermoglandular Flaps Tessier’S “Total Dermo-Mastopexy” and the “Yin-Yang Technique”
    BREAST SURGERY Breast Reduction With Dermoglandular Flaps Tessier’s “Total Dermo-Mastopexy” and the “Yin-Yang Technique” Francesco Gargano, MD, PhD,* Paul Tessier, MD,† and S. Anthony Wolfe, MD‡ skin and the gland and less “isolation” of the areola from the skin Abstract: The use of dermoglandular flaps in reduction mastopexy was and its vascular and nerve network. Because of this, there was advocated by Paul Tessier, who never published his method, but had actually greater security for the nipple and the skin flaps; but, the most rapid almost finished the following article before his death in June 2008. Dr. method seemed also to be a reason for its choice. Tessier is acknowledged as the “father” of craniofacial surgery, but he had The Ragnell procedure, and particularly the Biesenberger interest in aesthetic surgery, and was quite proud of the technique he procedure, has been criticized because of a lack of vascular security had developed using dermoglandular flaps in reduction mammoplasty. He associated with an extended dissection between the skin and the had literally hundreds of techniques and methods that he had developed but gland. During 1947 or 1948, I observed Mcindoe brilliantly per- which never found their way into print, both because of his enormous forming a Biesenberger procedure, and noted a good shape of the surgical schedule, and perhaps his self-imposed standards for anything that breast at the end of the operation. Thus, I began using the Biesen- he published, which were almost impossibly high. The technique proposed berger procedure in this pure form, but was never satisfied with my by Dr.
    [Show full text]
  • Surgical Options for Breast Cancer
    The Breast Center Smilow Cancer Hospital 20 York Street, North Pavilion New Haven, CT 06510 Phone: (203) 200-2328 Fax: (203) 200-2075 SURGICAL OPTIONS There are a number of surgical procedures available today for the treatment of breast cancer. You will likely have a choice and will need to make your own decision, in consultation with your specific surgeon, about the best option for you. We offer you a choice because the research on the treatment of breast cancer has clearly shown that the cure and survival rates are the same regardless of what you choose. The choices can be divided into breast conserving options (i.e. lumpectomy or partial mastectomy) or breast removing options (mastectomy). A procedure to evaluate your armpit (axillary) lymph nodes will likely occur at the same time as your breast surgery. This is done to help determine the likelihood that cells from your breast cancer have left the breast and spread (metastasized) to another more dangerous location. This information will be used to help decide about your need for chemotherapy or hormone blocking drugs after surgery. PARTIAL MASTECTOMY (LUMPECTOMY) A partial mastectomy involves removing the cancer from your breast with a rim, or margin, of normal breast tissue. This allows the healthy noncancerous part of your breast to be preserved, and usually will not alter the sensation of the nipple. The benefit of this surgical choice is that it often preserves the cosmetics of the breast. Your surgeon will make a decision about the volume of tissue that needs removal in order to maximize the chance of clear margins as confirmed by our pathologist.
    [Show full text]
  • Breast Reduction Questionnaire
    BREAST REDUCTION QUESTIONNAIRE Name Age Do you have any of the following: (Please check) ___Breast pain ....................................................... 611.1 ___Shoulder pain.................................................... 723.9 ___Neck pain.......................................................... 723.1 ___Upper back pain................................................ 724.1 ___Lower back pain................................................ 724.2 ___Rash beneath your breasts................................ 695.89 ___Finger or hand numbness.................................. 354.2 ___Bra strap indentation.......................................... ___Breast asymmetry.............................................. 611.8 ___Nipple discharge................................................. ___Difficulty examining your breast.......................... ___Fibrocystic breasts............................................. 610.0 ___Breast masses................................................... 611.72 ___Poor posture....................................................... Do you have difficulty finding properly fitting clothing as a result of your large breasts? Yes____ No____ Do you have to limit your physical activities as a result of your large breast size? Yes ____ No ____ Have you seen a physician, surgeon or chiropractor for treatment of back pain of problems related to your large breasts? Yes ____ No ____ Are you self-conscious about the size of your breast? Yes ____ No ____ How tall are you? How much do you weigh? Largest bra
    [Show full text]
  • Breast Lift (Mastopexy)
    BREAST LIFT (MASTOPEXY) The operation for breast lift is aimed at elevation of your normal breast tissue. This operation will not affect back, neck and shoulder pain due to the other problems such as arthritis. It also is not a weight loss procedure for obesity, nor will this operation correct stretch marks which may already be present. Often times this opera- tion is done to recreate symmetry if there is a large discrepancy in the shape of the two breasts. This operation has inherent risks asso- ciated with any surgery including infection, bleeding and the risk associated with the general anesthesia which is necessary. In addi- tion this operation results in scars around the areola and beneath the breast as has been described. It is impossible to lift the breasts with- out obvious scars. Although attempts and techniques will be made to minimize the scarring, this is an area of the body in which scars tend to widen due to location and the weight of the breasts. Revi- sion of these scars may be possible depending on their appearance following a 9-12 month healing period. In addition, these widened scars may be the result of delayed healing resulting from a small area of skin death in the portion where the two incisions come to- gether. This area is prone to a partial separation of the scar due to the tension and often times marginal blood supply in this area. This usually can be treated with local wound care including hydro- gen peroxide washes and application of a antibiotic ointment.
    [Show full text]
  • Therapeutic Mammaplasty Information for Patients the Aim of This Booklet Is to Give You Some General Information About Your Surgery
    Oxford University Hospitals NHS Trust Therapeutic mammaplasty Information for patients The aim of this booklet is to give you some general information about your surgery. If you have any questions or concerns after reading it please discuss them with your breast care nurse practitioner or a member of staff at the Jane Ashley Centre. Telephone numbers are given at the end of this booklet. Author: Miss P.G.Roy, Consultant Oncoplastic Breast Surgeon Oxford University Hospitals NHS Trust Oxford OX3 9DU page 2 Therapeutic mammaplasty This operation involves combining a wide local excision (also known as a lumpectomy) with a breast reduction technique resulting in a smaller, uplifted and better shaped breast. This means that the lump can be removed with a wide rim of healthy tissue. The nipple and areola are preserved with their intact blood supply and the remaining breast tissue is repositioned to allow reshaping of the breast. The scars are either in the shape of a lollipop or an anchor (as shown below). You may have a drain placed in the wound to remove excess fluid; this is usually left in for 24 hours. This procedure can be carried out on one or both of your breasts, as discussed with your surgeon. Vertical mammaplasty Lollipop scar Wise pattern Anchor shaped scar mammaplasty page 3 Your nipple is moved to a new position to suit your new breast shape and size but it may end up in a position different to your wishes. The surgeon will try to achieve a mutually agreed breast size whilst performing the operation; however a cup size cannot be guaranteed and there are likely to be further significant changes to your breast after radiotherapy.
    [Show full text]
  • Breast Uplift (Mastopexy) Procedure Aim and Information
    Breast Uplift (Mastopexy) Procedure Aim and Information Mastopexy (Breast Uplift) The breast is made up of fat and glandular tissue covered with skin. Breasts may change with variable influences from hormones, weight change, pregnancy, and gravitational effects on the breast tissue. Firm breasts often have more glandular tissue and a tighter skin envelope. Breasts become softer with age because the glandular tissue gradually makes way for fatty tissue and the skin also becomes less firm. Age, gravity, weight loss and pregnancy may also influence the shape of the breasts causing ptosis (sagging). Sagging often involves loss of tissue in the upper part of the breasts, loss of the round shape of the breast to a more tubular shape and a downward migration of the nipple and areola (dark area around the nipple). A mastopexy (breast uplift) may be performed to correct sagging changes in the breast by any one or all of the following methods: 1. Elevating the nipple and areola 2. Increasing projection of the breast 3. Creating a more pleasing shape to the breast Mastopexy is an elective surgical operation and it typifies the trade-offs involved in plastic surgery. The breast is nearly always improved in shape, but at the cost of scars on the breast itself. A number of different types of breast uplift operations are available to correct various degrees of sagginess. Small degrees of sagginess can be corrected with a breast enlargement (augmentation) only if an increase in breast size is desirable, or with a scar just around the nipple with or without augmentation.
    [Show full text]
  • Therapeutic Mammoplasty
    Therapeutic mammoplasty This information is for women undergoing a therapeutic mammoplasty and explains what happens during the operation, outlining the benefits, alternatives and risks of surgery. If there is anything that you do not understand or you have further questions or concerns please speak to one of the breast care nurses. Their contact details are listed at the end of this document. What is a therapeutic mammoplasty? Therapeutic mammoplasty is an operation to remove the breast cancer (therapeutic) and then reshape the breast by removing skin and breast tissue (mammoplasty), to try to preserve a normal breast shape that will usually be smaller and more uplifted. There is a limit to how much breast tissue can be removed with a standard lumpectomy without adversely affecting the appearance of the breast, but this technique allows us to remove more breast tissue and attempt to leave an acceptable cosmetic outcome. The operation is suitable for women with moderate to larger breasts, and who have a degree of droop (ptosis). If there is significant asymmetry (difference between your breasts) afterwards, the breast on the other side may also need to be reduced, to provide a better match in size and shape if so desired. This is known as symmetrisation surgery and will be performed at a later date. What are the advantages? • The technique aims to produce a normal breast shape with no indentation, distortion or loss of cleavage that might otherwise be likely. It is particularly useful for lower breast tumours that are more likely to develop a deformity if a simple lumpectomy is performed.
    [Show full text]
  • Lumpectomy/Mastectomy Patient/Family Education
    LUMPECTOMY/MASTECTOMY PATIENT/FAMILY EDUCATION Being diagnosed with breast cancer can be emotionally challenging. It is important to learn as much as possible about your cancer and the available treatments. More than one type of treatment is commonly recommended for breast cancer. Each woman’s situation is unique and which treatment or treatments that will be recommended is based on tumor characteristics, stage of disease and patient preference. Surgery to remove the cancer is an effective way to control breast cancer. The purpose of this educational material is to: increase the patient’s and loved ones’ knowledge about lumpectomy and mastectomy to treat breast cancer; reduce anxiety about the surgery; prevent post-operative complications; and to facilitate physical and emotional adjustment after breast surgery. THE BASICS There are three primary goals of breast cancer surgery: 1. To remove a cancerous tumor or other abnormal area from the breast and enough surrounding breast tissue to leave a “margin of safety” around the tumor or affected area. 2. To remove lymph nodes from the armpit area (axilla) to check for possible spread of cancer (metastasis) or remove lymph nodes that are already known to contain cancer. 3. Sometimes one or both breasts are removed to prevent breast cancer if a woman is at especially high risk for the disease. Breast cancer surgery can be done before or after chemotherapy (if chemotherapy is recommended). Radiation therapy and hormonal therapy (if recommended) are typically done after surgery. There are several types of breast surgery. The type of surgery best suited for a specific woman depends on the type of breast disease, the size and location of the breast disease/tumor(s) in the breast, and the personal preference of the patient.
    [Show full text]
  • Ductoscopy-Guided and Conventional Surgical Excision
    Breast Cancer Ductoscopy-guided and Conventional Surgical Excision a report by Seema A Khan, MD Department of Surgery Feinberg School of Medicine and Robert H Lurie Comprehensive Cancer Center of Northwestern University DOI: 10.17925/OHR.2006.00.00.1i Radiologic imaging is routinely used to evaluate unhelpful. Galactography has been used to evaluate women with spontaneous nipple discharge (SND), but women with SND with variable success.6,7 When SND definitive diagnosis is usually only achieved by surgical is caused by peripheral intraductal lesions, terminal duct excision (TDE). Ductoscopy has been galactography provides localizing information and can reported to result in improved localization of also assess the likelihood of malignancy,4 although intraductal lesions and may avoid surgery in women definitive diagnosis requires central or terminal duct with endoscopically normal ducts. excision (TDE). Duct excision is also therapeutic unless malignancy is discovered.2,8 Mammary endoscopy Nipple discharge is responsible for approximately 5% of (ductoscopy) is a recently introduced technique that annual surgical referrals.1 Not all forms of spontaneous may allow more precise identification and delineation nipple discharge (SND) are associated with significant of intraductal disease but is not currently a standard pathologic findings. The clinical features of SND that practice among most surgeons. Ductoscopy has been are associated with a high likelihood of intraductal reported to result in improved localization of neoplasia include unilaterality, persistence, emanation intraductal lesions9–11 and may avoid surgery in women from a single duct, and watery, serous, or bloody with endoscopically normal ducts. However, appearance.2,3 Discharges with these characteristics are ductoscopy adds to time and expense in the operating classified as pathologic and have traditionally been room (OR), and the yield of significant pathologic considered an indication for surgical excision of the lesions reported in separate series of women who are involved duct.
    [Show full text]
  • Lumpectomy and Mastectomy Surgery Comparison
    Lumpectomy and Mastectomy Surgery Comparison Surgery to remove cancer from the breast can be done with either lumpectomy or mastectomy. Your surgeon will tell you if one option is better for you than the other. Or, you may be eligible for both and must decide which procedure to have. Survival rate (chance of being alive at a certain time point) is the same with both surgeries. For this reason, both surgical options are considered equal in the treatment of breast cancer. Lumpectomy Lumpectomy is the removal of the part of the breast that has cancer. Other names for this surgery are segmental and partial mastectomy. This surgery is for patients who have a small area of disease in relation to breast size. Lumpectomy must be followed by radiation to be considered appropriate treatment. Radiation usually begins four to six weeks after surgery. For patients receiving partial breast radiation, treatment will begin about one week after surgery. There are several possible courses of radiation. Your radiation doctor will discuss the best course for you. Sometimes the cancer cannot be felt during a physical exam. When this happens, a wire or locator device will be placed in your breast the morning of surgery. Medicine to numb the involved area of the breast is given before this device is inserted. This wire or locator device will guide your surgeon to the area of the breast to be removed. Lumpectomy Pros and Cons Pros Cons Outpatient surgery. Greater possibility of re-excision (additional surgery). Shorter recovery. Usually requires radiation. No drain. Possible cosmetic change.
    [Show full text]
  • Reduction Mammoplasty Policy Number: PG0054 ADVANTAGE | ELITE | HMO Last Review: 02/13/2018
    Reduction Mammoplasty Policy Number: PG0054 ADVANTAGE | ELITE | HMO Last Review: 02/13/2018 INDIVIDUAL MARKETPLACE | PROMEDICA MEDICARE PLAN | PPO GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder contract. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. This guideline is solely for explaining correct procedure reporting and does not imply coverage and reimbursement. SCOPE X Professional _ Facility DESCRIPTION Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the breasts by removing excess fat, glandular tissue, and skin. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. Surgeons use different techniques, but the most common one involves an anchor-shaped incision that goes around the areola, down the breast toward the crease between the breast and abdomen, and then horizontally in the crease under the breast. The surgeon removes excess breast tissue, fat and skin to reduce the breast size. POLICY Reduction mammoplasty (19318) requires prior authorization for all product lines. COVERAGE CRITERIA HMO, PPO, Individual Marketplace, Elite/ProMedica Medicare Plan, Advantage Coverage for reduction mammoplasty is dependent on benefit plan language, may be subject to the provisions of a cosmetic and/or reconstructive surgery benefit and may be governed by state and/or federal mandates. Under many benefit plans, reduction mammoplasty is not covered when performed solely for the purpose of altering appearance or self-esteem or to treat psychological symptomatology or psychosocial complaints related to one’s appearance.
    [Show full text]
  • Breast Reduction Surgery (Policy OCA 3.44), Effective 08/01/21
    bmchp.org | 888-566-0008 wellsense.org | 877-957-1300 Medical Policy Breast Reduction Surgery Policy Number: OCA 3.44 Version Number: 22 Version Effective Date: 08/01/21 + Product Applicability All Plan Products Well Sense Health Plan Boston Medical Center HealthNet Plan Well Sense Health Plan MassHealth ACO MassHealth MCO Qualified Health Plans/ConnectorCare/Employer Choice Direct Senior Care Options ◊ Notes: + Disclaimer and audit information is located at the end of this document. ◊ The guidelines included in this Plan policy are applicable to members enrolled in Senior Care Options only if there are no criteria established for the specified service in a Centers for Medicare & Medicaid Services (CMS) national coverage determination (NCD) or local coverage determination (LCD) on the date of the prior authorization request. Review the member’s product-specific benefit documents at www.SeniorsGetMore.org to determine coverage guidelines for Senior Care Options. Policy Summary Breast reduction surgery (reduction mammoplasty) is considered medically necessary for symptomatic macromastia when Plan criteria are met for a female member (or a member born with female reproductive organs and/or with typical female karyotype with two [2] X chromosomes). The Plan complies with coverage guidelines for all applicable state-mandated benefits and federally-mandated benefits that are medically necessary for the member’s condition. Plan prior authorization is required for reduction mammoplasty. If applicable medical criteria are NOT met, the surgery is considered cosmetic. Breast Reduction Surgery + Plan refers to Boston Medical Center Health Plan, Inc. and its affiliates and subsidiaries offering health coverage plans to enrolled members. The Plan operates in Massachusetts under the trade name Boston Medical Center HealthNet Plan and in other states under the trade name Well Sense Health Plan.
    [Show full text]