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These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. bottom: 20px; Current concepts in gynaecomastia. Schnur et al (1991) reported on a sliding scale assigns a weight of breast tissue to be removed based on body weight and surface area. In these cases, breast reduction for men may take 2 to 3 hours. Plast Reconstr Surg. 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. Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. background-color: #663399; Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Ann Plast Surg. Thus, more than 1/3of operative subjects selected for inclusion in the study did not complete it; most of the operative subjects who did not complete the study were lost to follow-up. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. padding-bottom: 4px; Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Last Review01/04/2023. Nelson et al (2014b) separately conducted a population level analysis of the 2005-2011 NSQIP datasets, identifying patient who underwent reduction mammoplasty, to determine the impact of obesity on early complications after reduction mammoplasty. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Setala L, Papp A, Joukainen S, et al. Kerrigan CL, Collins ED, Striplin D, et al. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Breast pumps. Reduction mammoplasty for macromastia. 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. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Devalia HL, Layer GT. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. } In: Townsend CM, Beuchamp RD, Evers BM, eds. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. 2014b;30(6):641-647. Links to various non-Aetna sites are provided for your convenience only. Aesthetic Plast Surg. } Subjects were compared to age-matched norms from another study cohort. Many men with breast enlargement are found to have pseudo-gynecomastia. ASPS clinical practice guideline summary on reduction mammaplasty. Surg Laparosc Endosc Percutan Tech. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Tang CL, Brown MH, Levine R, et al. #backTop { li.bullet { Obstet Gynecol Clin North Am. 18th ed. Plastic Reconstr Surg. 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. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. 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. 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. Little is known about the effect of surgical treatment on the psychological aspects of the disease. J Plast Reconstr Aesthet Surg. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 2015;75(4):383-387. Fischer JP, Cleveland EC, Shang EK, et al. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. 1. .newText { In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. American Society of Plastic and Reconstructive Surgery (ASPRS). Khan SM, Smeulders MJ, Van der Horst CM. Breast and aesthetic surgery. Long-term functional results after reduction mammoplasty. Plastic Reconstr Surg. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). height:2px; 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). Gynecomastia in patients with prostate cancer: Update on treatment options. Kalliainen LK; ASPS Health Policy Committee. American Society of Plastic Surgeons (ASPS). 2014a;34(1):66-73. Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. 2015;49(6):363-366. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for The author concluded that the current level of evidence on this subject was very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. color: #FFF; Mayo Clin Proc. 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. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. 1999;103(6):1687-1690. In the case of reduction mammoplasty for relief of back, neck and shoulder pain, Aetna has considered this procedure medically necessary in women with excessively large breasts because it seems logical, even in the absence of firm clinical trial evidence, that this excessive weight would contribute to back and shoulder pain, and that removal of this excessive breast tissue would provide substantial pain relief, reductions in disability, and improvements in function. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. OL OL LI { The nipple-areola complex was re-positioned in 60 % of patients (n = 54). ASPS Recommended Coverage Criteria for Third Party Payors. border: none; background-color:#eee; } 1998;41(3):240-245. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Coding Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. 2015;(10):CD007258. Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. A study by Bruhlmann and Tschopp (1998) was a retrospective study of 246 patients from a surgical practice, approximately 50 % (132) of whom returned a questionnaire about their symptoms and satisfaction with aesthetic results, and their recollection of symptoms prior to surgery. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. 2010;125(5):1301-1308. Plast Reconstr Surg. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. J Am Coll Surg. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. color:#eee; Ann Plast Surg. For many patients the psychological impact of the disease is substantial. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. 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. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. 2001;76(5):503-510. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). The authorsleave the reader with the conclusionthat decisions about the medical necessity of breast reduction surgery in symptomatic women should be left entirely to the surgeon's discretion. 2001;108(1):62-67. Ann Plastic Surg. Aetna considers magnetic resonance imaging (MRI), with or without contrast materials, of the breast medically necessary for members who have had a recent (within the past year) conventional mammogram and/or breast sonogram, in any of the following circumstances where MRI of the breast may affect their clinical management:. Laituri CA, Garey CL, Ostlie DJ, et al. Ages ranged from 18 to 66 years. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Breast J. } In the case of breast reduction, however, for insurance purposes, it . To get insurance coverage, you'll probably need . Patient demographics, surgical technique, and outcomes were analyzed. The studies used to support the arguments for the medical necessity of breast reduction surgery are poorly controlled and therefore subject to a substantial risk of bias in the interpretation of results. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Women's Health and Cancer Rights Act of 1998. 2012;69(5):510-515. Oxfordshire NHS Trust. Plast Reconstr Surg. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. 40 . list-style-type : square !important; Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. 2017;35:157-161. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. text-decoration: line-through; Obesity and complications in breast reduction surgery: Are restrictions justified? The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. 1995;95(6):1029-1032. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. 2008;121(4):1092-1100. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Gland Surg. 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). In addition, Nguyen et al (2004) ignored a wealth of published evidence of the effectiveness of physical therapy, analgesics and other conservative measures on back and neck pain generally. J Pediatr Surg. A total of 90 patients underwent breast re-reduction surgery. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. Ann Chir Plast Esthet. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. A total of 182 thirty-day postoperative surgical complications were documented, but stratifying patients into 2 age groups did not reveal an association between age and any surgical complication (P = .26). Often times, insurance company will dictate how much breast tissue to be removed. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. This investigators stated that these studies should include data from older individuals affected by gynecomastia and utilize valid tools of psychological measurement in order to better quantify the effect; elderly patients affected by the disease have been over-looked in the current research; more data on this subject could improve the pre-operative evaluation of these patients and help identify the patients who will benefit from treatment. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. 1993;17(3):211-223. Plast Reconstr Surg. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. The Breast: Comprehensive Management of Benign and Malignant Diseases. Please check your insurance policy to see whether breast reduction is a covered procedure. Plast Reconstr Surg. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. 2015;49(6):311-318. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. 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. There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). The mean age was 42.8 years (SD 19.5 years). No author listed. 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 study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Plast Reconstr Surg. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. 2006;9(2):109-114. Guidelines for Adolescent Health Care. width: 100%; Policy. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Ann Plast Surg. 1991;27(3):232-237. Chadbourne EB, Zhang S, Gordon MJ, et al. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. Wound drainage after plastic and reconstructive surgery of the breast. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. Three review authors undertook independent screening of the search results. Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. 2002;109(5):1556-1566. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. cursor: pointer; 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. This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. .fixedHeaderWrap { Endocrinol Metab Clin North Am. Asian J Surg. Townsend: Sabiston Textbook of Surgery. 2000;45(6):575-580. 2009;7(2):114-119. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Arlington Heights, IL: ASPS; 2011. Surgeon. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. PLoS One. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. The end-point was the complete resolution of gynecomastia. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Ann Plast Surg. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Management of gestational gigantomastia. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. The condition not only must be unresponsive to dermatological treatments (e.g., antibiotics or antifungal therapy) and conservative measures (e.g., good skin hygiene, adequate nutrition) for a period of 6 months or longer, but also must satisfy criteria stated insection I above.