1998;41(3):240-245. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). Note: Chronic intertrigo, eczema, dermatitis, and/or ulceration in the infra-mammary fold in and of themselves are not considered medically necessary indications for reduction mammoplasty. Reduction mammaplasty: Defining medical necessity. Priorities Forum Policy Statement. Type II gynecomastia is more generalized breast enlargement. 2007;119(4):1159-1166. A total of 81 patients were included in this study. Hello! Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. No data were provided on loss to follow-up. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). Tang CL, Brown MH, Levine R, et al. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. .arrowPurpleSmall, a:hover.arrowPurpleSmall { Study subjects included 3538 patients with an average age of 43 years and body mass index of 31.6 kg/m(2) and most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes.The incidence of overall surgical complications was 5.1% and the incidence of major surgical complications was 2.1%. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Computed tomography scan of adrenal glands to identify adrenal lesions. Breast hypertrophy. The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). width: 100%; Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. padding: 15px; First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Narula HS, Carlson HE. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. ASPS Recommended Coverage Criteria for Third Party Payors. } Surgical treatment is indicated when medical treatments fail. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Arlington Heights, IL: ASPS; 2011. An 18-question survey was created evaluating various aspects of BBR practice; UK and Irish plastic and reconstructive and breast surgeons were invited to participate by an e-mail containing a link to a web-based survey. 1994;21(3):539-543. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Aetna considers breast reduction surgery medically necessary for non-cosmetic indications for women aged 18 or older or for whom growth is complete (i.e., breast size stable over one year) when any of the following criteria (A, B, or C) is met: Macromastia: all of the following criteria must be met: The authors concluded that breast re-reduction can be performed safely and predictably, even when the previous technique is not known; and 4 key principles were developed: Language services can be provided by calling the number on your member ID card. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. This may lead to additional scarring and additional operating time. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. display: none; 2005;58(3):286-289. Plast Reconstr Surg. Abnormal histopathological findings were more frequent in patients with reduction mammoplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. color: red The Mammotome procedure represented another novel therapeutic option for gynecomastia. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. If an insufficient amount of breast tissue is removed, the surgery is less likely to be successful in relieving pain and any related symptoms from excessive breast weight (e.g., excoriations, rash). A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. Emiroglu M, Salimoglu S, Karaali C, et al. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. background-color: #cc0066; Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Lonie S, Sachs R, Shen A, et al. The study subjects were stratified into groups based on ages of <60 years and 60 years. Ann Plast Surg. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). This will be computed based on your body area. z-index: 99; Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Kerrigan CL, Collins ED, Kim HM, et al. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. OL OL OL LI { Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Autorino R, Perdona S, D'Armiento M, et al. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. } #backTop { No necrosis, systemic infection, or muscle paralysis was reported. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Risk of bias was assessed independently by 2review authors. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . list-style-type: upper-alpha; Plast Reconstr Surg. Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). 2014a;34(1):66-73. Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. .newText { } Second, it is the burden of the proponent of an intervention to provide reliable evidence of its effectiveness, not the burden of ones whoquestion the effectivenessan intervention to provide definitive proof of ineffectiveness. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. } For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. /*margin-bottom: 43px;*/ Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Long-term functional results after reduction mammoplasty. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. OL OL OL OL OL LI { } In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. hr.separator { Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. 2nd ed. .strikeThrough { Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes.
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