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. No new trials were identified for this first update. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. 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. Plast Reconstr Surg. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Aesthet Plastic Surg. In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. 2015;75(4):383-387. Petty PM, Solomon M, Buchel EW, Tran NV. Ann Plast Surg. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Other just require 500 grams no matter what your height and weight. Saunders Co.; 1991. Obstet Gynecol Clin North Am. 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. 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. 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]. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Hello! Often times, insurance company will dictate how much breast tissue to be removed. 2021;147(5):1072-1083. A total of 81 patients were included in this study. Kerrigan CL, Collins ED, Kim HM, et al. Aesthet Surg J. 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. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Gynecomastia: A systematic review. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. 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. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. Plast Reconstr Surg. 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. 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). skin should not be excised horizontally below the inframammary fold. width: 100%; Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Ann Chir Plast Esthet. Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. text-decoration: line-through; Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Well-designed trials are especially important in assessing pain management interventions to isolate the contribution of the intervention from placebo effects, the effects of other concurrently administered pain management interventions, and the natural history of the medical condition. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio). Treatment of adolescent gynecomastia. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. Type II gynecomastia is more generalized breast enlargement. list-style-type: lower-roman; The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. height:2px; Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. } 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). } 2005;55(3):227-231. Am Surg. border-width:0; 2009;19(3):e85-e90. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. The Breast: Comprehensive Management of Benign and Malignant Diseases. } 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. The authors concluded that the limited evidence available showed no significant benefit of using post-operative wound drains in reduction mammoplasty, although LOS may be shorter when drains are not used. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Grooving where the bra straps sit on the shoulder. list-style-type: decimal; 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). 2001;108(6):1591-1599. Mizgala CL, MacKenzie KM. } In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Aesthetic Plast Surg. Reduction mammoplasty for macromastia. For many patients the psychological impact of the disease is substantial. 2008;53(3):255-261. 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). Horm Res Paediatr. 2005;58(3):286-289. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Tang CL, Brown MH, Levine R, et al. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. background-color: #cc0066; Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Ann Plast Surg. Gland Surg. J Plast Surg Hand Surg. The majority (87.7 %) of cases presented with accompanying mastalgia. For medical Tang CL, Brown MH, Levine R, et al. .newText { # font-weight: bold; Surgical implications of obesity. Schnur PL, Hoehn JG, Ilstrup DM, et al. Marshall WA, Tanner JM. Raispis T, Zehring RD, Downey DL. Bland KI, Copeland EM, eds. Seitchik MW. All the patients recovered well and were satisfied with the cosmetic outcomes. Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Reduction mammaplasty: Defining medical necessity. breast augmentation with implant. Kerrigan CL, Collins ED, Striplin D, et al. Arlington Heights, IL: ASPS; 2011. .strikeThrough { Breast pumps. Plast Reconstr Surg. 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. Endocrinol Metab Clin North Am. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). 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. Washington, DC: ACOG; 2011:121-122. Breast and aesthetic surgery. border-radius: 4px; Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. .headerBar { Risk of bias was assessed independently by 2review authors. Special Clinical Concerns. Gynecomastia in patients with prostate cancer: Update on treatment options. However, these medications should be reserved for those with no decrease in breast size after 2 years. 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. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. color: #FFF; Araco A, Gravante G, Araco F, et al. Patient demographics, surgical technique, and outcomes were analyzed. Please check your insurance policy to see whether breast reduction is a covered procedure. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. } Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. Long-term functional results after reduction mammoplasty. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. 2018;89(6):408-412. Krieger LM, Lesavoy MA. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. Statistical analysis was performed with student t-test and chi-square test. Hoyos AE, Perez ME, Dominguez-Millan R, et al. Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). Aesthetic Plast Surg. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Leclere FM, Spies M, Gohritz A, Vogt PM. Refer to the member's specific plan document for applicable coverage. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). 1993;91(7):1270-1276. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. #backTop:hover { Coding Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. 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. J Am Coll Surg. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Furthermore, the lack of an expected "dose-response" relationship between the amount of breast tissue removed and the magnitude of symptomatic relief in these studies raises questions about the validity of these studies and the effectiveness of breast reduction as a method of relieving shoulder and back pain. The primary outcome was the difference in wound drainage over 24 hours. The mean age was 42.8 years (SD 19.5 years). Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Prepubertal gynecomastia linked to lavender and tea tree oils. OL OL OL OL OL LI { Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Mistry RM, MacLennan SE, Hall-Findlay EJ. J Plast Reconstr Aesthet Surg. Blomqvist L, Eriksson A, Brandberg Y. Level of Evidence = III. The authors stated that operative subjects were told that their responses to the questionnaire were not to be used for insurance and thus the subjects had no motivation to exaggerate symptoms prior to surgery in questionnaire responses; however, it is not clear whether operative subjects would be willing to submit responses to a questionnaire from the doctor that differed substantially from the history that they provided to the doctor during their preoperative evaluation. @media print { Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics.
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