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Aetna considers the body lift perforator flap technique for breast reconstruction experimental and investigational because there is insufficient evidence to support the effectiveness of this approach.
Aetna considers the use of the following acellular dermal matrices medically necessary for breast reconstruction: Reduction or some cases augmentation mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary.
Surgical Correction ; or Repair of breast asymmetry due to a medically necessary mastectomy or a medically necessary lumpectomy that results in a significant deformity.
Wednesday 20 November (afternoon) A clean copy of the Business and Management case study is required for this examination paper. Read the case study carefully. Section A: answer two questions. With reference to RDB, distinguish between internal growth and external growth. DLWDB Database Information. prepared by. Daniel Lee Wenger © by Daniel Lee Wenger Santa Cruz, California. Additions and corrections should be sent to. The information on the page you requested has been marked private. To view the page, you will need to log in or register for Symantec Connect. If you are already logged in and still can't access the page, you don't have permission to view the page. Please contact the person who gave you the link to.
Aetna considers Biodesign Nipple Reconstruction Cylinder experimental and investigational becasue its effectiveness has not been established. Background Breast reconstruction surgery rebuilds a breast's shape after a mastectomy.
The surgeon forms a breast mound by using an artificial implant or autologous tissue from the abdomen, back or buttocks. Implants are silicone sacs filled with saline salt water or silicone gel.
The type of reconstruction performed depends on body type, age, general health status, type of cancer treatment or other reason for reconstruction. Breast reconstruction may involve insertion of tissue expanders or breast implants, capsulotomy, capsulectomy or removal of breast implants.
Procedure names are related to the muscles or blood supplying vessels used and involve surgically removing tissue, typically fat and muscle, from one area of the body to create a breast mound.
Pedicled flaps are positioned with their vascular origin intact while free flaps require microsurgery to connect the tiny blood vessels needed to supply the transplanted tissue.
This flap has been in use for 20 years and has provided excellent aesthetic results. However, a drawback of the TRAM flap is related to donor site morbidity of the abdomen.
The pedicle TRAM flap frequently requires use of the entire rectus abdominis muscle, while the free TRAM flap requires use of as little as a postage-stamp size portion of the muscle.
Perforator flaps have gained increasing attention with the realization that the muscle component of the TRAM flap does not add to the quality of the reconstruction and serves only as a carrier for the blood supply to the flap.
Thus, the concept of separating the flap skin, fat, artery, and vein from the muscle was realized as a means of minimizing the morbidity related to the abdominal wall and maintaining the aesthetic quality of the reconstruction.
The deep inferior epigastric perforator DIEP flap was introduced in the early 's and is identical to the free TRAM flap except that it contains no muscle or fascia. Use of this flap has been popular in the Europe for a number of years and is now gaining popularity in the United States.
Candidates for this operation are similar to those for the free TRAM in that there must be adequate abdominal fat to create a new breast. However, caution must be exercised in performing this technique in women who require large volume reconstruction to prevent the occurrence of fat necrosis or hardening of the new breast.
The operation can be performed immediately following mastectomy or on a delayed basis. Performance of this operation is slightly more difficult than the free TRAM flap because it requires meticulous dissection of the perforating vessels from the muscle.
Deep inferior epigastric perforator flaps tend to have less robust blood flow than is typical with a standard TRAM reconstruction, so careful patient selection is important.
Superior gluteal artery perforator SGAP flap or gluteal free flap procedures use tissue from the buttock to create the breast shape.
It is an option for women who cannot or do not wish to use the abdominal sites due to thinness, incisions, failed abdominal flap or other reasons. The method is much like the free TRAM flap mentioned above. Thin women who may not have much tissue in the lower abdominal area often have an adequate amount of tissue in the gluteal region.
The inferior gluteal artery perforator IGAP flap shares the same indications as the superior gluteal flap, namely the inability to use the TRAM flap and an abundance of soft tissue in the gluteal region.
The transverse upper gracilis TUG flap uses tissue from the upper posterior thigh and lower buttock area and is an option for women with insufficient lower abdominal fat for breast reconstruction.
The latissimus dorsi LD flap is tunneled through the axilla, leaving the blood supplying vessels the thoracodorsal artery and vein intact. The LD flap has less tissue volume and is usually used in combination with a saline or silicone implant.
Poland syndrome is an extremely rare developmental disorder that is present at birth congenital. It is characterized by absence agenesis or under-development hypoplasia of certain muscles of the chest e.
In most cases, physical abnormalities are confined to one side of the body unilateral. The range and severity of symptoms may vary from case to case.
The exact cause of Poland syndrome is not known. Autologous fat grafting or lipomodeling uses the patient's own fat cells to replace volume after breast reconstruction, or to fill defects in the breast following breast-conserving surgery NICE, Case Study.
You are ggiven the heads upp byy EMC that Microsoft PowerPoint - CACCN Sept Burn case study Author: Owner Created Date: 10/9/ PM. DLWDB Database Information. prepared by. Daniel Lee Wenger © by Daniel Lee Wenger Santa Cruz, California. Additions and corrections should be sent to.
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Social Media Dashboard For In-Depth Analytical Insights. read more. Number: Policy. Aetna considers reconstructive breast surgery medically necessary after a medically necessary mastectomy or a medically necessary lumpectomy that results in a significant deformity (i.e., mastectomy or lumpectomy for treatment of or prophylaxis for breast cancer and mastectomy or lumpectomy performed for chronic, severe fibrocystic breast disease, also known as .