Surgery
Chapter 4
Section 5.4
Reduction
Mammaplasty For Macromastia
Issue Date: October 22, 1985
Copyright: CPT only © 2006 American Medical
Association (or such other date of publication of CPT).
All Rights Reserved.
Revision:
2.0 DESCRIPTION
2.1 Reduction
mammaplasty is the surgical excision of a substantial portion of
the breast, including the skin and the underlying glandular tissue,
until a clinically normal size is obtained. Because breasts are
paired organs and macromastia usually affects both sides, bilateral
surgery is performed. When there is significant one-sided hypertrophy,
a unilateral breast reduction is performed. Reduction mammaplasty
is usually prompted by physical necessity due to the signs and symptoms
of macromastia, and is, therefore, reconstructive in nature.
2.2 Female breast hypertrophy,
macromastia, is the development of abnormally large breasts. This
condition can cause significant clinical manifestations when the
excessive breast weight adversely affect the supporting structures
of the shoulders, neck, and trunk. Macromastia is distinguished
from large, normal breast by the presence of persistent, painful
symptoms and physical signs.
Note: There are wide variations in
the range of normal individual height, body weight and associated
breast sizes; the amount of breast tissue that must be removed to
relieve symptoms therefore varies with the height and weight of
each patient (e.g., a small-statured person will need proportionally
less breast tissue removed to alleviate signs and symptoms of macromastia
than a larger person). Guidelines for determining whether breast
reduction is medically necessary include the Schnur sliding scale
[Schnur, Paul L, et al, “Reduction Mammaplasty: Cosmetic or Reconstructive
Procedure?” Annals of Plastic Surgery, September 1991; 27 (3): 232-7]
and InterQual guidelines.
3.0 POLICY
3.1 Reduction
mammaplasty is covered when signs and symptoms of macromastia are
functionally significant.
Note: Symptoms may include postural
backache, upper back and neck pain, and ulnar paresthesia. Appropriate physical
findings are “true” hypertrophy, and shoulder grooving and intertrigo.
Signs may include poor posture and the inability to participate
in normal physical activities. These may be functionally significant
in some individuals.
3.2 Photo-documentation
may be requested as part of a coverage determination.
4.0 EXCLUSIONS
4.1 Reduction
mammaplasties solely to treat fibrocystic disease of the breast.
4.2 Reduction mammaplasty performed
solely for cosmetic purposes.
4.3 Mastopexy
surgery.
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