DOCSLIB.ORG

Planning and Use of Therapeutic Mammoplasty— Nottingham Approach* S.J

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Planning and Use of Therapeutic Mammoplasty— Nottingham Approach* S.J British Journal of Plastic Surgery (2005) 58, 889–901 Planning and use of therapeutic mammoplasty— Nottingham approach* S.J. McCulley*, R.D. Macmillan Breast Reconstruction Service, Departments of Plastic Surgery and Breast Surgery, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK Received 4 July 2004; accepted 12 March 2005 KEYWORDS Summary Therapeutic mammaplasty, the use of reduction mammaplasty and Breast cancer; radiotherapy to surgically treat breast cancer, is an established technique for Breast conserving selected breast cancers and can extend the role of breast conserving surgery. Most surgery; frequently described is the use of a wise pattern reduction for tumours that lie within Reduction; the expected mammaplasty excision. However, mammaplasty techniques can be Mammaplasty; safely adapted to treat patients with cancers in all areas of the breast. An approach Therapeutic to selection and planning surgery is presented which has evolved from the experience mammaplasty of other units and our first 50 clinical cases over a 3-year period. The outcomes of these 50 cases are found in the accompanying article. Technique will vary depending upon the tumour position. Breast cancers may lie within the normal excision site of a recognised mammaplasty method (scenario A) or outside of the expected excision sites (scenario B). In scenario A, a range of recognised techniques can be performed without adaptation to widely excise the tumour and re-shape the breasts. In scenario B the techniques need to be adapted. Three decisions are needed for planning in scenario B; the skin incision, the nipple- aereola complex (NAC) pedicle orientation and finally the method of filling the cancer defect. The latter can be achieved by either extending the nipple pedicle or by creating a secondary pedicle within the breast dissection. Either method will move tissue that is normally excised into the cancer defect. For central tumours an inferior pedicle is usually used to both fill the defect and re-create the nipple. q 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. * The long-term oncological safety of breast conser- A smaller version of this article was presented at the Winter BAPS meeting in 2003. This included the clinical outcomes of the ving surgery (BCS) and radiotherapy for selected first 20 patients. The clinical outcomes of the first 50 are now women is accepted.1 The frequency of its use has being prepared in a separate publication. increased in recent years being more common than * Corresponding author. Address: Department of Plastic Sur- mastectomy as a treatment modality in most gery, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK. Tel.: C44 115 96 91169x46790; fax: C44 115 96 05216. centres. For the majority of patients a good or E-mail address: [email protected] (S.J. McCulley). excellent cosmetic outcome can be obtained. S0007-1226/$ - see front matter q 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2005.03.008 890 S.J. McCulley, R.D. Macmillan Predictors of poor outcome are tumour position,2 Indications and advantages for especially medial and inferior tumours and the therapeutic mammaplasty amount of breast tissue removed. As the proportion of breast removed increases so the chance of an The advantages are cosmetic and may also be acceptable cosmetic result decreases. Studies have oncological. The core role of therapeutic mam- suggested that depending on tumour site, removing maplasty is to avoid poor cosmetic results from more than 10–20% of the breast may risk an larger resections in breast conserving surgery. It 2 unsatisfactory cosmetic result. This can be associ- is ideal in most mediums to large breasted ated with poor psychological adjustment after woman providing the cancer is suitable for breast 3 breast cancer treatment. Larger percentage exci- conserving surgery. This technique extends the sions are more likely with larger tumours, smaller role of breast conserving surgery by improving breast sizes and surgical preference or protocol for cosmetic outcomes, not by fundamentally chan- quandrantectomy. Many centres now advocate the ging the indications. Patients with extensive DCIS use of oncoplastic techniques to help improve both or multi-focal disease will need treating with a the cosmetic and psychological outcomes in such mastectomy. It may play a role for tumours cases. Oncoplastic techniques available are direct reduced in size following neo-adjuvant treat- 4,5 volume replacement with autologous tissue, or ment.7 The techniques do also have a role in breast reshaping by therapeutic mammaplasty or selected smaller to medium breasted woman, 6–12 local-regional flaps. especially when ptosis is present. Even when Breast reduction techniques have been used in being smaller is not deemed ideal, it may be 6 the management of breast cancer since, the 1980’. preferred by a patient over mastectomy and total We prefer the term therapeutic mammaplasty as it reconstruction. Oncological indications are the avoids confusion over the indications and includes same as for standard breast conserving surgery some variations of technique that are unique to the including tumours up to 4 cm. There is little treatment of breast tumours. Clough et al. has evidence on which to assess the safety of breast- described the largest series of 101 patients over 15- conserving surgery for tumours over 4 cm.15 years and their findings support clinical and Another, more contentious group, include very 7 oncological safety. However, the methods large breasted woman with relatively small tumours described mostly relate to its use in large breasted who would benefit from a reduction mammaplasty patients and using a wise pattern reduction to for quality of life issues as well as having the cancer remove tumours that lie within the expected treated. This latter group are likely to have a good 6–8 mammaplasty excision. This is what we would cosmetic outcome from simple wide local excision describe as scenario A, where the tumour lies within but view reduction mammaplasty as a positive the expected area of excision and no adaptation of outcome of any cancer surgery. However, this technique is required. Losken described using group may have greater morbidity from post- different recognised pedicles for the nipple operative radiotherapy, which can be troublesome depending upon the tumour position.13 He also in large-breasted women.16,17 The homogeneity of discusses use of the pedicle to help fill the tumour the radiation dose, with skipping of areas, may be excision site to improve contour. This enables many less consistent in large breasts.18 tumours to be excised without adapting a known The alternative for many patients to therapeutic method and highlights the advantage of under- mammaplasty is mastectomy and total reconstruc- standing a range of recognised mammaplasty tion, either primary or delayed. In some instances techniques. where radiotherapy after mastectomy is likely, When a tumour lies outside of the expected immediate reconstruction is increasingly not excision site of most recognised mammaplasty advised. This is especially true for any implant techniques (scenario B) other modifications to based reconstruction. Autologous reconstruction mammaplasty techniques are required. Descrip- usually copes far better but can still be affected19 tions of cases do exist to both replace parenchyma (as may a breast treated by therapeutic mammo- and/or skin in such scenarios.14 These have usually plasty). When only one autologous option is involved the creation of secondary pedicles or available it is always a risk to knowingly give extending the breast reduction pillar. By adding to radiotherapy. As therapeutic mammoplasty rep- these options and importantly defining these resents BCS the patient will always be given adaptations over the last 3-years we have found radiotherapy for invasive tumours regardless of the planning of therapeutic mammoplasty is sim- grade, vascular invasion and lymph node status. For plified and its indications extended. such women, therapeutic mammaplasty may be an Planning and use of therapeutic mammoplasty—Nottingham approach 891 ideal option for a cosmetically acceptable result As this is breast conserving surgery radiotherapy from primary breast surgery plus radiotherapy. is required, which can affect the breast over time. The cosmetic outcome from therapeutic mam- This can range from acute changes to skin and maplasty is often similar to reduction mamma- parenchyma to simple volume asymmetry. This is plasty. Although autologous reconstruction can also usually from the nonirradiated breast increasing in give excellent cosmetic outcomes it will not volume to a greater degree than the irradiated ordinarily maintain the same degree of skin or breast. With the complexity of some therapeutic nipple sensation. Recovery from therapeutic mam- mammaplasty procedures it may be expected that maplasty is very similar to standard reduction wound or fat necrosis rates may be higher than mammaplasty and is likely to be quicker than the standard wide local excision. other options stated. Although undoubtably more It was stated under the ‘advantages’ that complicated than simple wide local excision (so patients who will definitely require radiotherapy adding operative time) this technique will avoid may be a good group to consider using therapeutic total reconstruction in many cases, which may
Load more

Recommended publications
  • Reduction Mammoplasty
    Reduction Mammoplasty Date of Origin: 02/1999 Last Review Date: 09/23/2020 Effective Date: 10/01/2020 Dates Reviewed: 05/1999, 10/2000, 09/2001, 03/2002, 05/2002, 08/2002, 10/2003, 10/2004, 09/2005, 11/2005, 01/2006, 02/2007, 02/2008, 02/2009, 07/2010, 02/2011, 01/2012, 10/2012, 08/2013, 07/2014, 10/2014, 12/2015, 05/2016, 06/2017, 08/2018, 02/2019, 09/2019, 09/2020 Developed By: Medical Necessity Criteria Committee I. Description A breast reduction, or reduction mammoplasty, is a surgical excision of a substantial portion of the breast including the skin and underlying glandular tissue, that reduces the size, changes the shape and/or lifts the breast tissue. Reduction mammoplasty may be approved on an individual basis when medical necessity has been established to relieve a physical functional impairment of members who are 16 years of age or older who have reached physical maturity. Reduction mammoplasty for cosmetic reasons is not a covered benefit. A reduction mammoplasty that is part of a reconstructive procedure related to breast cancer is not considered in this policy; See Moda Health Breast Reconstruction criteria. II. Criteria: CWQI HCS-0058A A. Reduction mammoplasty will be covered to plan limitations when ALL of the following criteria are met: a. The patient must be at least age 16 or older and/or Tanner stage V of Tanner staging of sexual maturity (See Addendum I for Tanner Staging) and ALL of the following: i. Patient’s weight has not changed in the past two years or has stabilized.
    [Show full text]
  • An Evaluation of 100 Symptomatic Women with Breast Implants Or Silicone Fluid Injections
    ORIGINAL ARTICLE Adjuvant Breast Disease: An Evaluation of 100 Symptomatic Women with Breast Implants or Silicone Fluid Injections Britta Ostermeyer Shoaib, Bernard M Patten and Dick S Calkins1 Department of Neurology, Baylor College of Medicine and 1Krug Life Science, Houston, TX, USA (Receivedfor publicationon December7, 1993) Abstract. We evaluated 100 referred women with breast implants (n=97) or silicone fluid injections (n=3) into breasts who developed various symptoms. All reported symptoms occurred at a median latency period of 6 years (range 0-24 years) after implantation or injection of silicone. Commonest symptoms were weakness (95%), fatigability (95%), myalgia (90%), morning stiffness (89%), arthralgia (81%), memory loss (81%), sensory loss (77%), headache (73%) and dry eyes and dry mouth (72%). Laboratory results revealed abnormal levels of serum immunoglobulins or complement in 57% and autoantibodies in 78%. Sural nerve biopsy was abnormal in 80% with the major finding of loss of myelinated fibers in 79%. Biceps muscle biopsy was abnormal in 58% with the major finding of neurogenic atrophy in 27%. Ninety six patients underwent implant removal; 60% of the patients were found to have one or both implants ruptured with silicone spilled into tissue. At time of removal, a pectoralis major muscle biopsy was taken which was abnormal in 89% with the major finding of neurogenic atrophy in 55%. Biopsy of implant capsule was abnormal in 94% showing foreign body giant cells containing retractile material consistent with silicone in 69% whether or not the elastomer shell was ruptured. Silicone can cause a systemic autoimmune disease with a variety of symptoms probably due to a global activation of the immune system.
    [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]
  • Medical Policy: Reduction Mammaplasty
    MEDICAL ASSOCIATES HEALTH PLANS AND HEALTH CHOICES HEALTH CARE SERVICES POLICY AND PROCEDURE MANUAL POLICY TITLE: REDUCTION MAMMOPLASTY POLICY STATEMENT: Medical Associates Health Plans (MAHP) and Health Choices (HC) has established specific criteria that must be met in order to provide coverage for reduction mammoplasty. The purpose of this Policy is to identify the criteria to be applied consistently to all cases where coverage is being requested. This document applies to eligible individuals who meet the clinical criteria and who have coverage under the scope and limitations of their benefit package. Services which are medically appropriate or indicated may not be approved for coverage based on exclusions and limitations of the benefit package. Policy MAHP and HC considers breast reduction surgery cosmetic unless breast hypertrophy is causing significant pain, paresthesia’s, or ulceration (see selection criteria below). Reduction mammoplasty for asymptomatic members is considered cosmetic. MAHP and HC considers breast reduction surgery medically necessary for non-cosmetic indications for women aged 18 or older or for whom growth is complete (i.e., breast size stable over one year) when any of the following criteria (I, II, or III) is met: I. Macromastia: all of the following criteria must be met: A. Member has persistent symptoms in at least 2 of the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least 1 year: . Headaches . Pain in neck . Pain in shoulders . Pain in upper back . Painful kyphosis documented by X-rays . Pain/discomfort/ulceration from bra straps cutting into shoulders . Skin breakdown (severe soft tissue infection, tissue necrosis, ulceration, hemorrhage) from overlying breast tissue .
    [Show full text]
  • Breast Implant Classification with MR Imaging Correlation1
    (Radiographics. 2000;20:e1-e1.) © RSNA, 2000 Online Only Breast Implant Classification with MR Imaging Correlation1 Michael S. Middleton, PhD, MD and Michael P. McNamara, Jr, MD 1 From the Department of Radiology, 410 Dickinson St, San Diego, CA 92103-8749 (M.S.M.) and Case Western Reserve University, Breast Imaging Center MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland, OH 44109-1998 (M.P.M.). Received July 8, 1999; revision requested December 13; revision received and accepted December 21. Abstract Rupture is now recognized as an important and common complication of TOP breast implants. Magnetic resonance (MR) imaging is the most accurate Abstract method for evaluating implant integrity but requires an understanding of the LEARNING OBJECTIVES numerous variations in implant construction that are encountered clinically. Introduction To assist in diagnosis, the authors provide an MR-oriented breast implant Materials and Methods classification scheme based on data from 4,014 patients (>9,966 current or Description of Implant Types previous implants), the literature, and other primary documentation. This Discussion scheme consists of 14 implant types: 1) single-lumen silicone gel-filled, 2) Conclusions single-lumen gel-saline adjustable, 3) single-lumen saline-, dextran-, or References polyvinyl pyrrolodone-filled, 4) standard double-lumen, 5) reverse double-lumen, 6) reverse-adjustable double-lumen, 7) gel-gel double-lumen, 8) triple-lumen, 9) Cavon "cast gel", 10) custom, 11) solid pectus, 12) sponge (simple or compound), 13) sponge (adjustable), and 14) other. The MR imaging and mammographic appearance of many implant types is correlated with their actual appearance after explantation. A brief history of prosthetic breast augmentation and reconstruction is also provided to allow this classification method to be placed in historical perspective.
    [Show full text]
  • Occult Pathologic Findings in Reduction Mammaplasty in 5781 Patients—An International Multicenter Study
    Journal of Clinical Medicine Article Occult Pathologic Findings in Reduction Mammaplasty in 5781 Patients—An International Multicenter Study Britta Kuehlmann 1,2 , Florian D. Vogl 3, Tomas Kempny 4, Gabriel Djedovic 5, Georg M. Huemer 6, Philipp Hüttinger 7, Ines E. Tinhofer 8, Nina Hüttinger 9, Lars Steinstraesser 10, Stefan Riml 11, Matthias Waldner 12 , Clark Andrew Bonham 1, Thilo L. Schenck 13, Gottfried Wechselberger 14, Werner Haslik 15, Horst Koch 16, Patrick Mandal 17, Matthias Rab 18, Norbert Pallua 19, Lukas Prantl 2 and Lorenz Larcher 20,* 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, CA 94305, USA; [email protected] (B.K.); [email protected] (C.A.B.) 2 University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef, 93053 Regensburg, Germany; [email protected] 3 Breast Health Center, General Hospital Merano, SABES South Tyrol, 39012 Meran, Italy; fl[email protected] 4 Division of Plastic and Reconstructive Surgery, Department of Surgery, Klinikum Wels-Grieskirchen, 4600 Wels-Grieskirchen, Austria; [email protected] 5 Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, 6020 Innsbruck, Austria; [email protected] 6 Section of Plastic Surgery, Kepler University Hospital, 4020 Linz, Austria; [email protected] 7 Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital St. Poelten, 3100 St. Poelten,
    [Show full text]
  • Breast Reduction
    Medical Coverage Policy Effective Date ............................................. 8/15/2021 Next Review Date ....................................... 8/15/2022 Coverage Policy Number .................................. 0152 Breast Reduction Table of Contents Related Coverage Resources Overview .............................................................. 1 Acupuncture Coverage Policy ................................................... 1 Breast Reconstruction following Mastectomy or General Background ............................................ 2 Lumpectomy Medicare Coverage Determinations .................... 6 Chiropractic Care Coding/Billing Information .................................... 6 Complementary and Alternative Medicine Physical Therapy References .......................................................... 7 Surgical Treatment of Gynecomastia Treatment of Gender Dysphoria INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description
    [Show full text]
  • Breast Surgery Corporate Medical Policy
    Breast Surgery Corporate Medical Policy File Name: Breast Surgery File Code: UM.SURG.17 Origination: 2016 Last Review: 11/2019 Next Review: 11/2020 Effective Date: 04/01/2020 Description/Summary This policy focuses on breast-related procedures that include mastectomy for cancer, prophylactic mastectomy, reconstruction, the management of breast implants, breast reductions, corrections for certain asymmetries. BCBSVT covers medically necessary procedures related to physiological dysfunction, such as breast cancer, congenital and developmental disorders, infection, trauma, surgical complications and macromastia causing physiological dysfunction in men and women. BCBSVT considers procedures that are only performed to reshape normal structures of the body in order to improve one’s appearance or self-esteem only, to be cosmetic and therefore non-covered as benefit exclusions. Policy Coding Information Click the links below for attachments, coding tables & instructions. Attachment I – CPT®/HCPCS Coding Table Requests for breast surgery should be accompanied by the following documentation: • The name and date of the proposed surgery. • Date of accident or injury, if applicable • History of present illness and/or conditions including diagnoses • Documentation of diagnosis, functional impairment, pain or significant anatomic variance • How the treatment can be reasonably expected to improve the functional impairment • If applicable, the description of and CPT® coding for planned staged procedure following acute repair, within two years of previous stage or initial primary repair • Any additional information listed for a specific procedure as indicated for the specific procedures listed below. Page 1 of 15 Medical Policy Number: UM.SURG.17 BCBSVT will review procedures intended to correct complications from a cosmetic procedure, whether the original procedure was medically necessary or a non-covered service.
    [Show full text]
  • Augmentation Mammaplasty Silicone Gel
    JANA COLE, MD DANIEL SUVER, MD Informed Consent – Augmentation Mammaplasty Silicone Gel INSTRUCTIONS This is an informed-consent document that has been prepared to help inform you about augmentation mammaplasty surgery with silicone gel-filled implants, its risks, as well as alternative treatment(s). It is important that you read this information carefully and completely, and sign the consent for surgery as proposed by your plastic surgeon and agreed upon by you. GENERAL INFORMATION In November 2006, silicone gel-filled breast implant devices were approved by the United States Food and Drug Administration (FDA) for use in breast augmentation and reconstruction. Augmentation mammaplasty is a surgical operation performed to enlarge the female breasts for a number of reasons: • To enhance the body contour of a woman who, for personal reasons, feels that her breast size is too small. • To correct a loss in breast volume after pregnancy. • To balance breast size, when there is a significant difference between the sizes of the breasts. • To restore breast shape after partial or total loss of the breasts in various conditions. • To correct a failure of breast development due to a severe breast abnormality. • To correct or improve the results of existing breast implants for cosmetic or reconstructive reasons. Breast implant surgery is contraindicated in women with untreated breast cancer or pre-malignant breast disorders, active infection anywhere in the body, or individuals who are currently pregnant or nursing. Individuals with a weakened immune system (currently receiving chemotherapy or drugs to suppress the immune system), conditions that interfere with blood clotting or wound healing, or reduced blood supply to the breast tissue from prior surgery or radiation therapy treatments may be at greater risk for complications and poor surgical outcomes.
    [Show full text]
  • Augmentation Mammaplasty Saline
    JANA COLE, MD DANIEL SUVER, MD Informed Consent – Augmentation Mammaplasty Saline INSTRUCTIONS This is an informed-consent document that has been prepared to help inform you about augmentation mammaplasty surgery with saline implants, its risks, as well as alternative treatment(s). It is important that you read this information carefully and completely and sign the consent for surgery as proposed by your plastic surgeon and agreed upon by you. GENERAL INFORMATION Augmentation mammaplasty is a surgical operation performed to enlarge the breasts for a number of reasons: • To enhance the body contour of a woman who, for personal reasons, feels that her breast size is too small. • To correct a loss in breast volume after pregnancy. • To balance breast size, when there is a significant difference between the sizes of the breasts. • To restore breast shape after partial or total loss of the breasts in various conditions. • To correct or improve the results of existing breast implants for cosmetic or reconstructive reasons. Breast implant surgery is contraindicated in women with untreated breast cancer or pre-malignant breast disorders, active infection anywhere in the body, or individuals who are currently pregnant or nursing. Individuals with a weakened immune system (currently receiving chemotherapy or drugs to suppress the immune system), conditions that interfere with blood clotting or wound healing, or reduced blood supply to the breast tissue from prior surgery or radiation therapy treatments may be at greater risk for complications and poor surgical outcomes. According to the United States Food and Drug Administration (FDA), a woman must be at least 18 years of age in order to undergo cosmetic breast augmentation with saline-filled breast implants.
    [Show full text]
  • Breast Reconstruction Following Mastectomy Or Lumpectomy
    Medical Coverage Policy Effective Date ............................................. 4/15/2021 Next Review Date ....................................... 3/15/2022 Coverage Policy Number .................................. 0178 Breast Reconstruction Following Mastectomy or Lumpectomy Table of Contents Related Coverage Resources Overview .............................................................. 1 Botulinum Therapy Coverage Policy ................................................... 1 Breast Implant Removal General Background ............................................ 4 Complex Lymphedema Therapy (Complete Medicare Coverage Determinations .................. 20 Decongestive Therapy) Coding/Billing Information .................................. 20 Injectable Fillers References ........................................................ 24 Panniculectomy and Abdominoplasty Pneumatic Compression Devices and Compression Garments Reduction Mammoplasty Redundant Skin Surgery Scar Revision Surgical Treatment of Chest Wall Deformities Surgical Treatments for Lymphedema and Lipedema Tissue-Engineered Skin Substitutes INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard
    [Show full text]
  • Post-Mastectomy Surgery and Services Clinical Coverage Criteria
    Post-Mastectomy Surgery and Services Clinical Coverage Criteria Overview The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy. The WHCRA, enacted October 21, 1998, amended the Public Health Service Act (PHS Act) and the Employee Retirement Income Security Act of 1974 (ERISA). The WHCRA is administered by the Department of Health and Human Services and the Department of Labor. The WHCRA applies to group health plans and individual insurance policies. Group heath plans can either be insured or self-funded. The WHCRA does not apply to Medicare or Medicaid. As required by the Women’s Health and Cancer Rights Act (WHCRA) of 1998, Fallon Health provides coverage for the following services in a manner determined in consultation with the attending physician and the plan member: All stages of reconstruction of the breast on which the mastectomy has been performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and Treatment of physical complications of mastectomy, including lymphedema. Coverage cannot be denied based upon the period of time between the mastectomy and the request for reconstructive surgery; because the member had the mastectomy prior to joining a plan; or because the mastectomy was not as a result of cancer (despite the title, nothing in the WHCRA limits the benefit to cancer patients). Also, despite the title, nothing in the law limits WHCRA entitlements to women. The WHCRA does not prohibit health plans from imposing copayments, deductibles, or coinsurance requirements on health benefits in connection with a mastectomy and reconstruction as long as such requirements are consistent with those established for other benefits under the plan.
    [Show full text]