DOCSLIB.ORG

Reduction Mammaplasty [For the List of Services and Procedures That Need Preauthorization, Please Refer To

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Clinical Medical Policy Department Clinical Affairs Division Reduction Mammaplasty [For the list of services and procedures that need preauthorization, please refer to www.mcs.com.pr. Go to “Comunicados a Proveedores”, and click “Cartas Circulares”.] [Coverage for MCS Life Commercial Only] [For MCS Advantage Classicare LOB Coverage, please refer to Local Coverage Determination for Reduction Mammaplasty (L33939)] Medical Policy: MP-SU-03-09 Original Effective Date: April 23, 2009 Revised: February 2, 2021 Next Revision: February, 2022 This policy applies to products subscribed by the following corporations, MCS Life Insurance Company (Commercial), and MCS Advantage, Inc. (Classicare) and Medical Card System, Inc., provider’s contract; unless specific contract limitations, exclusions or exceptions apply. Please refer to the member’s benefit certification language for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply subject to the aforementioned exceptions. DESCRIPTION Breast Reduction Surgery, also known as Reduction Mammaplasty, is a surgical procedure to remove excess breast fat, glandular tissue and skin, in order to achieve a breast size in proportion with the human body and to alleviate the discomfort associated with overly large breasts. The justification for reduction mammaplasty should be based on the probability of relieving the clinical signs and symptoms of symptomatic breast hypertrophy. Symptomatic breast hypertrophy is defined as a syndrome of persistent neck and shoulder pain, painful shoulder grooving from brassiere straps, chronic intertriginous rash of the inframammary fold, and frequent episodes of headache, backache, and neuropathies caused by an increase in the volume and weight of breast tissue beyond normal proportions. Because it is difficult to determine the size at which breast enlargement becomes pathologic in any individual, the position of the American Society of Plastic Surgeons is that the definition of symptomatic breast hypertrophy should focus on the degree of symptomatology, not the degree of breast hypertrophy present (cup size or amount of tissue removed). (ASPS, 2017). Breasts are pair organs and breast hypertrophy when present generally affects both sides. Therefore, when surgery is needed it is usually performed bilaterally. However, unilateral surgery may be performed if medically reasonable and necessary (CMS L33939, 2019). The appropriate surgical approach should be determined by the physician and patient in accordance with the patient’s clinical situation. Considering that reduction mammaplasty may be used for both medically necessary and cosmetic indications, MCS has set the criteria below to distinguish medically necessary reduction mammaplasty from cosmetic reduction mammaplasty. COVERAGE Benefits may vary between groups and contracts. Please refer to the appropriate member certificate and subscriber agreement contract for applicable diagnostic imaging, DME, laboratory, machine tests, benefits and coverage. This document is designated for informational purposes only and is not an authorization, or an explanation of benefits (EOB), or a contract. 1 Medical technology is constantly changing and we reserve the right to review and update our policies periodically. Medical Card System, Inc. 1 All Rights Reserved® Clinical Medical Policy Department Clinical Affairs Division INDICATIONS Medical Card System, Inc. (MCS) will consider Reduction Mammaplasty medically necessary when indications below, 1 plus 2; or 3 are met: 1. Performed in the presence of macromastia/breast hypertrophy and have documented symptoms that involve two (2) anatomic areas of the body and the condition must adversely affect activities of daily living, (ADLs), for at least one (1) year. a. Signs and symptoms will include: i. History of back, neck and shoulder pain, cervicalgia and torticollis; ii. Ulnar paresthesias (Evidenced by a Nerve Conduction Studies); iii. Acquired kyphosis documented by x-rays; iv. Intertrigonous maceration or infection of the inframammary (e.g., bleeding, hyperpigmentation, chronic moisture, evidence of skin breakdown), skin refractory to dermatologic measures. v. Shoulder grooving with skin irritation (e.g., areas of excoriation and breakdown) by supporting garment. vi. History of significant arthritic changes in the cervical or upper thoracic spine, optimally managed with persistent symptoms and/or significant restriction of activity. 2. A history of documented persistent pain symptoms, despite an attempted trial period of at least three (3) months of therapeutic measures, such as: a. Supportive devices (e.g., such as garments, back brace, etc.,); b. Conservative analgesic and non-steroidal anti-inflammatory drugs (NSAIDs) interventions; c. Compresses, massage; d. Physical therapy, and/or e. Correction of obesity. 3. Reconstruction of the affected and the contralateral unaffected breast following a medically necessary mastectomy is considered a relatively safe and effective noncosmetic procedure. This document is designated for informational purposes only and is not an authorization, or an explanation of benefits (EOB), or a contract. 2 Medical technology is constantly changing and we reserve the right to review and update our policies periodically. Medical Card System, Inc. 2 All Rights Reserved® Clinical Medical Policy Department Clinical Affairs Division Accordingly, program payment may be made for breast reconstruction surgery following removal of a breast for any medical reason. (For more information regarding coverage criteria under this scenario, please refer to medical policy MP-SU-02-10 - Breast Reconstruction Following Mastectomy or Lumpectomy. Note1: Submission of pre-operative photographs is not required unless a specific request is made. Photographs should demonstrate the implication that supports the reduction mammaplasty procedure. Providers should maintain photographs in the medical record and make them available upon request. CONTRAINDICATIONS/LIMITATIONS Medical Card System, Inc. (MCS) does NOT consider Reduction Mammaplasty medically necessary in ANY of the following criteria: 1. Individuals under the age of 18 years, 2. Reduction mammaplasty performed solely for improvement of aesthetic appearance without signs and symptoms of functional abnormality affecting activities of daily living (ADL’s). 3. Surgery solely being performed to treat psychological symptomatology or psychosocial complaints. 4. MCS contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary. CODING INFORMATION CPT® Codes (List may not be all inclusive) CPT® Codes DESCRIPTION 19318 Reduction mammaplasty 2020 Current Procedural Terminology (CPT®) Professional Edition. American Medical Association: Chicago, IL. Note2: To report bilateral procedure, report modifier 50 with the procedure code. (AMA CPT® Professional Edition, 2020). Note3: Modifier -LT should be used for left breast reduction. Modifier -RT should be used for right breast reduction (AMA, HCPCS Level II Professional, 2020). ICD-10 Codes (List may not be all inclusive) ICD-10-Codes DESCRIPTION L26 Exfoliative dermatitis L30.4 Erythema intertrigo L53.8 Other specified erythematous conditions L54 Erythema in diseases classified elsewhere This document is designated for informational purposes only and is not an authorization, or an explanation of benefits (EOB), or a contract. 3 Medical technology is constantly changing and we reserve the right to review and update our policies periodically. Medical Card System, Inc. 3 All Rights Reserved® Clinical Medical Policy Department Clinical Affairs Division L92.0 Granuloma annulare L95.1 Erythema elevatum diutinum L98.2 Febrile neutrophilic dermatosis [Sweet] M25.511 Pain in right shoulder M25.512 Pain in left shoulder M25.519 Pain in unspecified shoulder M40.00 Postural kyphosis, site unspecified M40.03 Postural kyphosis, cervicothoracic region M40.04 Postural kyphosis, thoracic region M40.05 Postural kyphosis, thoracolumbar region M40.14 Other secondary kyphosis, thoracic region M40.202 Unspecified kyphosis, cervical region M40.203 Unspecified kyphosis, cervicothoracic region M40.204 Unspecified kyphosis, thoracic region M40.205 Unspecified kyphosis, thoracolumbar region M40.209 Unspecified kyphosis, site unspecified M40.294 Other kyphosis, thoracic region M43.6 Torticollis M53.82 Other specified dorsopathies, cervical region M54.2 Cervicalgia M54.6 Pain in thoracic spine M54.89 Other dorsalgia M54.9 Dorsalgia, unspecified M95.4 Acquired deformity of chest and rib N62 Hypertrophy of breast N64.2 Atrophy of breast N64.4 Mastodynia Q83.0 Congenital absence of breast with absent nipple Q83.8 Other congenital malformations of breast R20.0 Anesthesia of skin R20.1 Hypoesthesia of skin R20.2 Paresthesia of skin R20.3 Hyperesthesia R20.8 Other disturbances of skin sensation R20.9 Unspecified disturbances of skin sensation R21 Rash and other nonspecific skin eruption R29.5 Transient paralysis This document is designated for informational purposes only and is not an authorization, or an explanation of benefits (EOB), or a contract. 4 Medical technology is constantly changing and we reserve the right to review and update our policies periodically. Medical Card System, Inc. 4 All Rights Reserved® Clinical Medical Policy Department Clinical Affairs Division R51 Headache Z42.1 Encounter for breast reconstruction
Recommended publications
  • Breast Reduction with Dermoglandular Flaps Tessier’S “Total Dermo-Mastopexy” and the “Yin-Yang Technique”

    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.
  • Back Pain: an Assessment in Breast Hypertrophy Patients

    Back Pain: an Assessment in Breast Hypertrophy Patients

    ORIGINAL ARTICLE BACK PAIN: AN ASSESSMENT IN BREAST HYPERTROPHY PATIENTS PAULO MAGALHÃES FERNANDES1, MIGUEL SABINO NETO2, DANIELA FRANCESCATO VEIGA3, LUIS EDUARDODUARDO FELIPE ABLABLA4, CARLOS DELANO ARAÚJO MUNDIM 5, YARAARA JULIANOULIANO6,� LYDIAYDIA MASAKOASAKO FERREIRAERREIRA7 SUMMARY used in order to evaluate the magnitude of back pain and Objective – To evaluate the influence of breast hypertrophy on the limitations arising from these symptoms. Results – The the incidence of back pain and how much they can interfere in mean age of the patients in the study group was 32.2 years patients’ daily activities. Methods – This was a cross-sectional and 32.7 for the control group. The scores in the NRS scale analytic study in patients examined at the Outpatient Ortho- and Roland- Morris Questionnaire were higher in the study pedics and Plastic Surgery Departments at Samuel Libânio group when compared to the control group. Conclusion – The University Hospital in Pouso Alegre, MG. 100 women were results achieved showed that back pain is more severe and examined, 50 presenting breast hypertrophy (study group) determined more extensive limitations in the daily activities and 50 with normal breast size (control group). Breasts were for patients presenting breast hypertrophy. classified according to Sacchini’s criteria. The Numerical Ra- ting Scale (NRS) and the Roland-Morris questionnaire were Keywords: Back pain; Quality of life; Neck pain; Breast. Citation: Fernandes PM, Sabino Neto M, Veiga DF, Abla LEF, Mundim CDA, Juliano Y et al. Back pain: an assessment in breast hypertrophy patients. Acta Ortop Bras. [serial on the Internet]. 2007; 15(4): 227-230. Available from URL: http://www.scielo.br/aob.
  • Reduction Mammoplasty

    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.
  • Breast Reduction Questionnaire

    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
  • An Evaluation of 100 Symptomatic Women with Breast Implants Or Silicone Fluid Injections

    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.
  • Spectrum of Breast Disorders in a Pediatric Surgery Clinic: Retrospective Study

    Spectrum of Breast Disorders in a Pediatric Surgery Clinic: Retrospective Study

    Article ID: WMC003775 ISSN 2046-1690 Spectrum of Breast Disorders in A Pediatric Surgery Clinic: Retrospective Study Corresponding Author: Dr. Atilla Senayli, Assistant Prof., Pediatric Surgery, Yildirim Beyazit University - Turkey Submitting Author: Dr. Atilla Senayli, Assistant Prof., Pediatric Surgery, Yildirim Beyazit University - Turkey Article ID: WMC003775 Article Type: Original Articles Submitted on:26-Oct-2012, 05:59:39 AM GMT Published on: 26-Oct-2012, 06:25:34 PM GMT Article URL: http://www.webmedcentral.com/article_view/3775 Subject Categories:PAEDIATRIC SURGERY Keywords:Breast; Disorders; Children How to cite the article:Senayli A, Karaveliolu A , Koseoglu B , Akln M , Ozguner I . Spectrum of Breast Disorders in A Pediatric Surgery Clinic: Retrospective Study . WebmedCentral PAEDIATRIC SURGERY 2012;3(10):WMC003775 Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source(s) of Funding: None Competing Interests: None WebmedCentral > Original Articles Page 1 of 7 WMC003775 Downloaded from http://www.webmedcentral.com on 26-Oct-2012, 06:25:34 PM Spectrum of Breast Disorders in A Pediatric Surgery Clinic: Retrospective Study Author(s): Senayli A, Karaveliolu A , Koseoglu B , Akln M , Ozguner I Abstract Paediatricians must pay attention to breast disorders that may be seen at any paediatric age group. (1). Objective: There are a limited and inadequate data Although most of the diseases are benign as a fact, for breast diseases in children. This may be because the possibility of malignancy can never be ignored of low importance expectations of practitioners' for (1-3).
  • Therapeutic Mammaplasty Information for Patients the Aim of This Booklet Is to Give You Some General Information About Your Surgery

    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.
  • Journal of Clinical Review & Case Reports

    Journal of Clinical Review & Case Reports

    ISSN: 2573-9565 Case Report Journal of Clinical Review & Case Reports Pseudo Angiomatous Stromal Hyperplasia of the Breast: A Case of A 19-Year-Old Asian Girl Yuzhu Zhang1, Weihong Zhang2# , Yijia Bao1, Yongxi Yuan1,3* 1Department of Mammary gland, Longhua Hospital Affiliated to Shanghai University of TCM, Shanghai, China *Corresponding author 2Department of Mammary gland, Baoshan branch of Shuguang Yongxi Yuan, Department of Mammary gland, Longhua Hospital Hospital Affiliated to Shanghai University of TCM, Shanghai,201900, Affiliated to Shanghai University of TCM & Huashan Hospital, China. Shanghai Medical College, Fudan University, Shanghai, China. Tel: +8602164383725; Email: [email protected] 3Department of Mammary gland, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Submitted: 11 Oct 2017; Accepted: 20 Oct 2017; Published: 04 Nov 2017 #co-first author Abstract Pseudoangiomatous stromal hyperplasia (PASH), a benign disease with extremely low incidence, is manifested as giant breasts, frequent relapse after surgery, or endocrine disorder. Cases with unilateral breast and undetailed endocrine condition have been reported in African and American. In this case, a 19-year-old Asian girl suffered from bilateral breast PASH after the human placenta and progesterone treatment for 3-month delayed menstruation. Her breasts enlarged remarkably 1 month after the treatment, with extensive inflammatory swell in bilateral mammary glands and subcutaneous edema in retromammary space. The patient received the bilateral quadrantectomy plus breast reduction and suspension surgery to terminate the progressive hyperplasia of breast. During the whole treatment period, the patient was given tamoxifen treatment for 4 months, and endocrine levels were intensively recorded. The follow-up after 4 months showed recovered breast with normal shape and size, and there was no distending pain, a tendency toward breast hyperplasia, or menstrual disorder.
  • 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

    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.
  • Juvenile Breast Hypertrophy

    Juvenile Breast Hypertrophy

    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Via Medica Journals ONLINE FIRST This is a provisional PDF only. Copyedited and fully formatted version will be made available soon. ISSN: 0423-104X e-ISSN: 2299-8306 Juvenile breast hypertrophy Authors: Benedita Bianchi de Aguiar, Rita Santos Silva, Carla Costa, Cintia Castro-Correia, Manuel Fontoura DOI: 10.5603/EP.a2019.0063 Article type: Clinical Vignette Submitted: 2019-12-07 Accepted: 2019-12-16 Published online: 2020-01-07 This article has been peer reviewed and published immediately upon acceptance. It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Endokrynologia Polska" are listed in PubMed. The final version may contain major or minor changes. Powered by TCPDF (www.tcpdf.org) Juvenile breast hypertrophy Benedita Bianchi de Aguiar1, Rita Santos Silva2, Carla Costa2, Cintia Castro-Correia2, Manuel Fontoura2 1Paediatrics Department, Centro Hospital Entre Douro e Vouga, Portugal 2Paediatrics Endocrinology, Centro Hospitalar Universitário de São João, Portugal Correspondence to: Benedita Sousa Amaral Bianchi de Aguiar, Rua Marta Mesquita da Câmara 175 Apt 62 4150-485 Porto, Portugal, tel: (+351) 913 166 913; e-mail: [email protected] Case description Juvenile breast hypertrophy (JBH), also called virginal hypertrophy or macromastia, is a rare benign condition, in which one or both breasts undergo a massive increase in size duringin puberty, usually around menarche. We present a clinical case of JBH and discuss the available therapeutic options. An 11-year- old female patient was referred to our paediatric endocrinologist consultant due to breast hypertrophy.
  • Breast Reduction Surgery (Policy OCA 3.44), Effective 08/01/21

    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.
  • W O 2019/232146 Al 05 December 2019 (05.12.2019) W IPO I PCT

    W O 2019/232146 Al 05 December 2019 (05.12.2019) W IPO I PCT

    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property (1) Organization11111111111111111111111I1111111111111i1111liiiii International Bureau (10) International Publication Number (43) International Publication Date W O 2019/232146 Al 05 December 2019 (05.12.2019) W IPO I PCT (51) International Patent Classification: JIANG, Zaoli; 20 Cedar Rock Road, Woodbridge, Con A61K31/19(2006.01) A61K45/00(2006.01) necticut06525(US). A61K38/12 (2006.01) A61K 45/08 (2006.01) (74) Agent: DOYLE, Kathryn et al.; Saul Ewing Arnstein & (21) International Application Number: Lehr LLP, 1500 Market Street, 38th Floor, Philadelphia, PCT/US2019/034548 Pennsylvania 19102 (US). (22) International Filing Date: (81) Designated States (unless otherwise indicated, for every 30 May 2019 (30.05.2019) kind ofnational protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, BZ, (25)FilingLanguage: English CA, CH, CL, CN, CO, CR, CU, CZ, DE, DJ, DK, DM, DO, (26) Publication Language: English DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, HN, (30)PriorityData: HR, HU, ID, IL, IN, IR, IS, JO, JP, KE, KG, KH, KN, KP, (30)/Priority : 01 June 2018 (01.06.2018) us KR, KW, KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (71) Applicant: YALE UNIVERSITY [US/US]; Two Whitney OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, Avenue, New Haven, Connecticut 06510 (US). SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, ZA, ZM, ZW.