Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Fischer S, Hirsch T, Hirche C, et al. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. --> Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Ann Plast Surg. Computed tomography scan of adrenal glands to identify adrenal lesions. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. And if you are in Canada the surgeon decides. This will be computed based on your body area. .headerBar { 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. display: none; J Plast Reconstr Aesthet Surg. Gynecomastia. list-style-type: decimal; } All the patients recovered well and were satisfied with the cosmetic outcomes. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. (25 y/o female with a 38J bra size) according to aetna, I should more than qualify for a reduction as I have back, neck, shoulder pain, chest pain and pressure, arm numbness while laying on sides, etc. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Reduction mammaplasty: An outcome study. Major complications (1.6 %) included unilateral hematoma and localized infection. World J Surg. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Li CC, Fu JP, Chang SC, et al. Level of Evidence = IV. 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. Breast cancer found at the time of breast reduction. Breast Concerns of Adolescents. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. cursor: pointer; Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. 1999;103(6):1682-1686. Annu Rev Med. Philadelphia, PA: W.B. 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). Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review 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). Surgical treatment of gynecomastia: Complications and outcomes. Arlington Heights, IL: ASPS; March 9, 2002. 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. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. 2008;121(4):1092-1100. Marshall WA, Tanner JM. skin should not be excised horizontally below the inframammary fold. Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. Collis N, McGuiness CM, Batchelor AG. Copyright Aetna Inc. All rights reserved. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. Horm Res Paediatr. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . J Laparoendosc Adv Surg Tech A. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Narula HS, Carlson HE. Arlington Heights, IL: ASPRS; 1987. Nguyen JT, Wheatley MJ, Schnur PL, et al. Breast reduction for symptomatic macromastia. Oxfordshire NHS Trust. In this study the National Surgical Quality Improvement Program data set was queried for the Current Procedural Terminology code 19318 from the years 2005 to 2010, with principal outcome measurements of wound complications, surgical site infections, and reoperations. Laituri CA, Garey CL, Ostlie DJ, et al. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. A total of 15 articles met the inclusion criteria for review. 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. Principles of breast re-reduction: A reappraisal. Can objective predictors for operative success be identified? } Priorities Forum Policy Statement. J Am Coll Surg. Arch Dis Child. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Plast Reconstr Surg. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Surgical treatment of primary gynecomastia in children and adolescents. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Plastic Reconstruct Surg. A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammoplasty regarding physical symptoms and body image. Plast Reconstr Surg. cursor: pointer; Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Townsend: Sabiston Textbook of Surgery. } color: white; The health burden of breast hypertrophy. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. 2000;45(6):575-580. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Prostate Cancer Prostatic Dis. font-size: 18px; You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. Mizgala CL, MacKenzie KM. This Clinical Policy Bulletin may be updated and therefore is subject to change. The average age was 24.7 years (range of 18 to 47 years). Philadelphia, PA: WB Saunders Company; 2008; Ch 73. height:2px; They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). } As explained below, 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 cohort study of breast cancer risk in breast reduction patients. 2015;75(4):370-375. 2015;75(4):383-387. 2001;108(6):1591-1599. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Aesthet Surg J. 1995;34(2):113-116. Washington, DC: ACOG; 2011:121-122. Surg Laparosc Endosc Percutan Tech. Wound drainage after plastic and reconstructive surgery of the breast. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Am Surg. Kasielska-Trojan A, Danilewicz M, Antoszewski B. 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). Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . Little is known about the effect of surgical treatment on the psychological aspects of the disease. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. background-color: #cc0066; Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. .strikeThrough { For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). 1997;100(4):875-883. 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. 2012;130(4):785-789. Hoyos AE, Perez ME, Dominguez-Millan R, et al. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). A total of 81 patients were included in this study. Also, there was no correlation between PR expression and 2D: 4D. 1996;20(5):391-397. # color: white; 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. Mistry RM, MacLennan SE, Hall-Findlay EJ. @media print { A systematic search of the published literature was performed. 2016;20(3):256-260. Plastic Reconstruct Surg. text-decoration: underline; 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). OL OL OL LI { Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. In other patients, excess skin and nipple and areola relocation are necessary. GP Notebook. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . 2018;7(Suppl 1):S70-S76. Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy. 1998;49:215-234. J Plast Surg Hand Surg. Well-designed clinical trials provide reliable information about the effectiveness of an intervention, and provide valid information about the characteristics of patients who would benefit from that intervention. 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. 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. J Plast Reconstr Aesthet Surg. In these cases, breast reduction for men may take 2 to 3 hours. 2008;53(3):255-261. The member has gigantomastia of pregnancy accompanied byany of the following complications, and delivery is not imminent: For medical necessity criteria for surgery to correct breast asymmetry, seeCPB 0185 - Breast Reconstructive Surgery. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. American Society of Plastic Surgeons (ASPS). 2014;20(3):274-278. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. 2000;44(2):125-134. Blomqvist L, Eriksson A, Brandberg Y. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Variations in pattern of pubertal changes in girls. 2015;10(8):e0136094. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. No necrosis, systemic infection, or muscle paralysis was reported. Patient demographics, surgical technique, and outcomes were analyzed. 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., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Many men with breast enlargement are found to have pseudo-gynecomastia. All patients underwent routine investigations to exclude secondary causes of gynecomastia. 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. The study subjects were stratified into groups based on ages of <60 years and 60 years. border-radius: 4px; These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Plast Reconstr Surg. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). 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. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. PLoS One. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Brown DM, Young VL. American Society of Plastic and Reconstructive Surgery (ASPRS). This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Disproportionately large breasts can cause both physical and emotional . The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Sugrue CM, McInerney N, Joyce CW, et al. 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. Reduction mammoplasty for macromastia. border-width:0; Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Long-term functional results after reduction mammoplasty. 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. Gynecomastia in patients with prostate cancer: Update on treatment options. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass The nipple-areola complex was re-positioned in 60 % of patients (n = 54). 2021;147(5):1072-1083. Ages ranged from 18 to 66 years. 2017;35:157-161. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Treating providers are solely responsible for medical advice and treatment of members. Please check your insurance policy to see whether breast reduction is a covered procedure. Ann Plast Surg. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Two review authors undertook independent data extraction of study characteristics, methodological quality and outcomes (e.g., infection, other wound complications, pain, and length of hospital stay [LOS]). When seeking preauthorization for a breast reduction, your goal is generally twofold. Current concepts in gynaecomastia. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Gynecomastia has been classified into2 types. Gynaecomastia. Hello! Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. Pediatr Surg Int. Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. 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). 1995;95(1):77-83. In a review on Surgical treatment of primary gynecomastia in children and adolescents, Fischer et al (2014b) concluded that surgical correction of gynecomastia remains a purely elective intervention. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. top: 0px; } Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Krieger LM, Lesavoy MA. Gland Surg. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. 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. 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. 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. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Prepubertal gynecomastia linked to lavender and tea tree oils. Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. list-style-type: upper-roman; Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial.
Chris Geere Parents,
Our Lady Of Peace, Lynbrook Bulletin,
Articles A