Breast Surgery. The Insured must provide documentation in the form of a written psychological assessment from at least one qualified behavioral health provider experienced in treating Gender Dysphoria. The assessment must document that the Insured meets all of the following criteria: Has persistent, well-documented Gender Dysphoria; Has the capacity to make a fully informed decision and to consent for treatment; Must be 18 years or older; and If significant medical or mental health concerns are present, they must be reasonably well controlled.
Breast Surgery. Surgery for male or female breast reduction is NOT COVERED, except when associated with breast reconstructive surgery in connection with a Medically Necessary mastectomy as set forth in Section 3.14 of this Certificate.
Breast Surgery. As soon as possible following recovery from neoadjuvant therapy and after the final clinical tumor assessment, the patient should undergo a lumpectomy or mastectomy. · Breast conservation may be selected according to patient and surgeon preferences. - Patients who are not considered candidates for breast conservation or do not desire breast conservation will undergo a total mastectomy with or without immediate breast reconstruction. - Patients who are deemed to be good candidates for breast conservation will undergo segmental excision of the primary tumor bed. If the residual tumor is non-palpable, methods to insure adequate excision of the primary tumor site should be used to guide the excision. If tumor location was marked with clips, a specimen radiograph should be obtained intraoperatively to document that the lesion has been removed including the clips. Hemoclips should be inserted at the base of the segmental mastectomy operative site to facilitate radiotherapy treatment planning of the actual tumor bed. - The margins of the resected specimen of patients treated with breast conservation must be histologically free of invasive tumor and DCIS. In patients for whom pathologic examination demonstrates tumor at the margin, additional operative procedures should be performed to obtain clear margins.
