Ann Chir Plast Esthet. Collins ED, Kerrigan CL, Kim M, et al. Plast Reconstr Surg. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. 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 . } Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. American Society of Plastic Surgeons (ASPS). They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Ages ranged from 18 to 66 years. Long-term functional results after reduction mammoplasty. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. 2021;147(5):1072-1083. 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. No data were provided on loss to follow-up. Leclere FM, Spies M, Gohritz A, Vogt PM. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. background-color:#eee; Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. 2010;125(5):1301-1308. While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. Schnur PL, Schnur DP, Petty PM, et al. ASPS clinical practice guideline summary on reduction mammaplasty. Many men with breast enlargement are found to have pseudo-gynecomastia. 2014a;34(1):66-73. 1994;21(3):539-543. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Breast Concerns of Adolescents. } Exposure to partners using estrogen containing vaginal creams; Cancer chemotherapy (alkylating agents, methotrexate, vinca alkaloids, imatinib, combination chemotherapy), Androgen receptor blockers - bicalutamide, 5 reductase inhibitors - finasteride, dutasteride, Angiotensin converting enzyme inhibitors (captopril, enalapril), Calcium channelblockers(diltiazem, nifedipine, verapamil), Anabolic steroids(e.g., in body builders). 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. 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%. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. list-style-type: upper-alpha; Links to various non-Aetna sites are provided for your convenience only. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). cursor: pointer; For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. 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 If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. z-index: 99; Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Mizgala CL, MacKenzie KM. position: fixed; 2011;128(4):243e-249e. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. 2008;53(3):255-261. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. OL OL OL OL LI { Coding The authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). 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. 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. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Analysis was on an intention-to-treat basis. 2020 Sep 4 [Online ahead of print]. 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). Reduction mammoplasty improves symptoms of macromastia. 1999;103(6):1687-1690. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Does Health Insurance Cover Breast Reduction Surgery? - GoodRx Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. 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:. Gynecomastia may be drug-induced. } Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Aesthetic Plast Surg. Aesthet Surg J. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. The health burden of breast hypertrophy. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. 2006;30(3):309-319. Plastic Reconstr Surg. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Kasielska-Trojan A, Danilewicz M, Antoszewski B. My Experience of Having Breast Reduction Surgery - Health Reduction mammaplasty: The need for prospective randomized studies. list-style-type: decimal; OL OL OL LI { Breast and aesthetic surgery. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Philadelphia, PA: W.B. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. 2019;8(4):431-440. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Washington, DC: ACOG; 2011:121-122. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Quality of life after breast reduction. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. 1996;20(5):391-397. 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. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . 1993;17(3):211-223. of the following criteria must be met: Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. In other patients, excess skin and nipple and areola relocation are necessary. Pain/discomfort/ulceration from bra straps cutting into shoulders; Skin breakdown (severe soft tissue infection, tissue necrosis, ulceration hemorrhage) from overlying breast tissue; There is a reasonable likelihood that the member's symptoms are primarily due to macromastia; Reduction mammoplasty (also spelled as 'mammaplasty') is likely to result in improvement of the chronic pain; Pain symptoms persist as documented by the physician despite at least a 3-month trial of therapeutic measures such as: Analgesic/non-steroidal anti-inflammatory drugs (NSAIDs) interventions and/or muscle relaxants, Dermatologic therapy of ulcers, necrosis and refractory infection, Physical therapy/exercises/posturing maneuvers, Supportive devices (e.g., proper bra support, wide bra straps), Chiropractic care or osteopathic manipulative treatment. breast augmentation with implant. Arlington Heights, IL: ASPS; May 2011. .newText { 2001;108(6):1591-1599. The authors (Nguyen et al, 2004) argue, based primarily on the results of the ASPS-funded BRAVO study (described below), that (with a single exception) no objective criteria for breast reduction surgery are supportable, including criteria based upon the presence of particular signs or symptoms, requirements based upon breast size or the amount of breast tissue removed, any minimum age limitations, any limitation based upon maximum body weight, requirements for a trial of conservative therapy, or the exclusion of certain procedures (liposuction). 1997;100(4):875-883. hr.separator { Breast Reduction Surgery | Johns Hopkins Medicine Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Subjects were compared to age-matched norms from another study cohort. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Aesthetic Plast Surg. Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. 2 . 2000;106(5):991-997. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Krieger LM, Lesavoy MA. width: 100%; Howrigan P. Reduction and augmentation mammoplasty. How to make Aetna pay for your breast reduction surgery And if you are in Canada the surgeon decides. Breast cancer found at the time of breast reduction. 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. In a systematic review, these investigators examined the role of radiotherapy in this context. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. 1998;41(3):240-245. list-style-type: lower-roman; color: white; Breast J. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Oxford, UK: National Health Service (NHS); October 2008. 1995;61(11):1001-1005. 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. Clinical Policy: Reduction Mammoplasty and Gynecomastia Surgery - WellCare 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. 2006;118(4):840-848. Devalia HL, Layer GT. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Also, there was no correlation between PR expression and 2D: 4D. The Mammotome procedure represented another novel therapeutic option for gynecomastia. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Plast Reconstr Surg. Laituri CA, Garey CL, Ostlie DJ, et al. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. 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). Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Risk factors for complications following breast reduction: Results from a randomized control trial. 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). This Clinical Policy Bulletin may be updated and therefore is subject to change. 2000;106(2):280-288. 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.