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. 1996;20(5):391-397. bottom: 20px; cursor: pointer; Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. 18th ed. Plast Reconstr Surg. } 2015;(10):CD007258. 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. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the 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. 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. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Guidelines for Adolescent Health Care. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Ann Plast Surg. 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. A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. 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. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. American Society of Plastic and Reconstructive Surgery (ASPRS). 2014b;48(5):334-339. The risks included infection, wound breakdown, scarring, and the need for re-operating. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Three review authors undertook independent screening of the search results. 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. }. 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. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). 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). Ann Plast Surg. Ann Plast Surg. and areola. list-style-type: lower-roman; Plastic Reconstruct Surg. 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. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. 01/04/2023 The following procedures are considered experimental and investigational because there is insufficient evidence of itseffectiveness or itseffectiveness has not been established: Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. No statistically significant differences in the drainage, level of pain, size of open areas, clinical appearance, degree of scar pliability, or scar erythema were noted. Refer to the member's specific plan document for applicable coverage. Measuring health state preferences in women with breast hypertrophy. Prostate Cancer Prostatic Dis. of . Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. The Mammotome procedure represented another novel therapeutic option for gynecomastia. 2001;107(5):1234-1240. OL LI { 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. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Washington, DC: ACOG; 2011:121-122. All the patients recovered well and were satisfied with the cosmetic outcomes. Reduction mammaplasty. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Breast J. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Tang CL, Brown MH, Levine R, et al. 2000;106(2):280-288. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. 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. 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). padding-bottom: 4px; There were 18 out of 415 studies eligible to review. Breast J. They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. 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. Major complications (1.6 %) included unilateral hematoma and localized infection. Ann Plast Surg. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. 2010;45(3):650-654. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Please check your insurance policy to see whether breast reduction is a covered procedure. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 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. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Oxfordshire NHS Trust. Breast and aesthetic surgery. } 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. 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). Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. This conclusion is based primarily upon the Breast Reduction Assessment of Value and Outcomes (BRAVO) study, which is described in several articles (Kerrigan et al, 2001; Kerrigan et al, 2002; Collins et al, 2002). 1995;34(2):113-116. Blomqvist L, Eriksson A, Brandberg Y. 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). Also, there was no correlation between PR expression and 2D: 4D. This Clinical Policy Bulletin may be updated and therefore is subject to change. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. 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. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Arlington Heights, IL: ASPRS; 1987. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. J Plast Reconstr Aesthet Surg. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Treating providers are solely responsible for medical advice and treatment of members. 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. Pediatr Surg Int. 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. 2007;36(2):497-519. 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; 1999;103(6):1682-1686. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Plast Reconstr Surg. Arlington Heights, IL: ASPS; 2011. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Quality of life after breast reduction. 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.

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