Breast Reduction Surgery: Is it Cosmetic Surgery, Reconstructive Surgery, or Doesn’t It Matter?

Wednesday, January 3rd, 2018 by doctor

Breast Reduction Surgery: Is it Reconstructive Surgery, Cosmetic Surgery or Doesn’t It Matter? Will my health insurance cover the surgery?

I recently saw a female college student, as a new patient consultation concerning “Breast Reduction Surgery”. This procedure also known as “Reduction Mammaplasty” is indicated for the treatment of symptomatic macromastia (large breasts). The commonly reported symptoms related to macromastia are that of: neck, shoulder and back pain secondary to the weight of the large breasts upon the musculoskeletal system. Other secondary symptoms include: breast pain and dermatitis or rashes beneath the breasts.
This above patient was referred by her gynecologist and arrived with a “prescription” recommending a consultation with a “plastic surgeon”. The patient believed, as many do, that since she was referred by her physician, that the surgery would be covered by her health insurance plan. She was requesting that the surgery be scheduled in four weeks, during her “winter recess” from college.
After completing a patient history and regional breast examination, my staff proceeded to explain to her the procedure necessary to try and obtain insurance authorization for her requested and indicated surgery. She had no other medical treatment or consultations concerning her macromastia. No history of being referred for physical therapy, chiropractic treatment, orthopedic consultation, or dermatology exam. The patients understanding of the “health insurance system” was that, if her referring physician recommended her for treatment, it must be a medically indicated and covered procedure.
Reconstructive Surgery vs. Cosmetic Surgery: It is universally believed by patients, that if a surgery is classified or considered “reconstructive”, it is medically indicated and an insurance covered procedure. This usually means to patients, that all fees related to that procedure will be paid by their health insurance. And if a procedure is considered “cosmetic”, it is not a medically indicated and covered procedure. It is my opinion that for years, breast reduction surgery has been thought of as a “Hybrid”. It is considered “reconstructive” in attempts to obtain insurance coverage for the surgery. It is considered “cosmetic” in that patients expect meticulous aesthetic expertise in the surgery and the post-surgical results. In our practice, it has recently become extremely difficult to obtain insurance coverage for breast reduction surgery. Insurance companies frequently require 2-3 documented reports from other referred specialists. Also the insurance companies commonly requests 6-12 months of documentation and treatment by either a: physical therapist, chiropractor, dermatologist or orthopedist.
Do Your Homework: The intent of this blog is simple and I hope that everyone who reads it understands one point. If you feel that you are a candidate for breast reduction surgery, and requesting coverage under your health insurance, it is important that you contact your health insurance carrier, and have them forward to you in writing, what their criteria are for coverage. Every insurance company has difference, independent criteria and indications, and one should not confuse the fact that “my friend” got it covered by her insurance, and she had “smaller breasts” than me. On the average, it takes between 3-6 months of preparation, seeking secondary consultations with other healthcare providers and possible therapy (physical therapy or chiropractics). Notify your primary care physician as soon as possible concerning any symptoms which may be related to your macromastia. It is never too early to start the process, and remember that what the insurance company’s criteria are this year might not be the same next year. Please contact our office concerning any questions you might have that relate to breast reduction surgery and coverage through your health insurance.

Facial Cosmetic Chin Surgery and Chin Augmentation

Tuesday, January 2nd, 2018 by doctor

“Doctor, I have no chin.” I can’t tell you how many times I hear that from a patient. It is a regular concern of many of my cosmetic facial surgery patients. In a majority of these cases, the patients report that they had prior orthodontics at one time in their life. And, in most of these cases, the patients usually states that they had a deep overbite.

Cosmetic chin surgery (genioplasty) can be performed on patients who have: a recessed or small chin, a large or protruding chin, or an asymmetric or crooked chin. During the consultation, the surgeon will examine not only the patient’s profile, which is usually the most concerning to the patient, they will examine the patient’s “dental bite” or occlusion. I will be reviewing “small or recessed” chin in this blog, and other chin deformities in future posts.

Pre-operative evaluation
The surgeon may recommend that the patient have a special radiograph to evaluate the boney architecture of the jaws, and its relationship to the skull bones (cephalogram). In a majority of the cases, the patient’s lower jaw is anatomically positioned further back than normal, in comparison to the upper jaw.

Treatment options
Alloplastic genioplasty
If the patient is only cosmetically concerned about their small chin, and not the position of their teeth or jaws, then there are two common options for this patient. The patient can have the placement of a chin implant. The implant is fabricated from a form of synthetic material. The implants come in many sizes and shapes. The surgeon will perform measurements of the patient’s facial aesthetics to determine what size implant will give the patient the cosmetic profile desired. The implants are surgically placed through an incision either through the mouth or under the chin. The surgery is commonly performed as an outpatient procedure with the assistance of local anesthesia and/or intravenous sedation.

Horizontal Sliding Genioplasty
This is another form of surgical procedure, in which the “boney” chin is surgically cut with a precision saw from inside the mouth. This boney chin segment is horizontally “slid” forward, giving the patient an enhanced chin profile. The boney segment is then secured and fixated in this new position, with a combination of specific plates and screws. In this procedure in comparison to the above, the patient’s own bone is used to perform the augmentation vs. a synthetic implant. However, the extent of the surgery and post-operative course is greater.

Additional cosmetic facial surgery
I commonly recommend and perform a genioplasty (chin implant) on patients in combination with a facelift or neck lift. Chin implants are also commonly recommended in cases of rhinoplasty when the patient presents with a recessed chin. This presentation actually makes the nose appear larger and out of proportion to the rest of the face.

Post-operative course
The patient may be placed into a compression dressing on the chin for 3-5 days after surgery. There will be moderate swelling and bruising of the chin and neck region for 7-10 days after the surgery. In the case of the sliding genioplasty, there is a chance of numbness to the lip, usually temporary, after the surgery. This is due to the extent of the swelling, and stretching of the soft tissues forward. In both types of genioplasty, the final cosmetic results are not apparent for approximately 2-3 months after the surgery, to allow for all of the swelling and bruising to resolve.

Do Your Homework