(This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Tang CL, Brown MH, Levine R, et al. 2009;7(2):114-119. Breast. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Plast Reconstr Surg. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Seitchik MW. Breast Concerns of Adolescents. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). 18th ed. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Surgical management of gynecomastia--a 10-year analysis. This may lead to additional scarring and additional operating time. Ann Plast Surg. } color: blue 1995;95(6):1029-1032. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. 2007;36(2):497-519. In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. 2019;166(5):934-939. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Recommended criteria for insurance coverage of reduction mammoplasty. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. padding-bottom: 4px; Plast Reconstr Surg. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. N Engl J Med. A total of 90 patients underwent breast re-reduction surgery. text-decoration: line-through; Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia. Laituri CA, Garey CL, Ostlie DJ, et al. Asian J Surg. hr.separator { top: 0px; An average of 320 specimens were excised from each side with mean blood loss of 34 ml. 2012;69(5):510-515. The average age was 24.7 years (range of 18 to 47 years). OL OL OL OL OL LI { Oxfordshire NHS Trust. border: none; Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. 2021;147(5):1072-1083. Horm Res Paediatr. A systematic search of the published literature was performed. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Aesthet Plastic Surg. list-style-type: upper-alpha; Devalia HL, Layer GT. Raispis T, Zehring RD, Downey DL. Prostate Cancer Prostatic Dis. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Another set of breast pump supplies if you get pregnant . Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. } Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). There were only 2 studies of a total 25 patients that were considered as good in quality. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. 2020 Sep 4 [Online ahead of print]. Ann Plast Surg. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. list-style-type: lower-roman; 1999;103(6):1687-1690. The mean volume of tissue resected was 250 g (range of 22 to 758 g) from the right breast and 244 g (range of 15 to 705 g) from the left breast. 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. Plast Reconstr Surg. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Please check your insurance policy to see whether breast reduction is a covered procedure. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. 2007;119(4):1159-1166. } Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. 2003;111(2):688-694. Operative subjects who completed the study reported reductions in pain and improvements in quality of life; however, these improvements may be attributable to placebo effects, the natural history of back pain, other concurrent interventions, regression to the mean, improvements in cosmesis (for quality of life measures), or other confounding variables that may bias in interpretation of results. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Endocrinol Metab Clin North Am. }. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Plastic Reconstr Surg. 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). Reduction mammaplasty: Defining medical necessity. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Breast reduction outcome study. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. 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. Coding 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. list-style-type: lower-alpha; 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. In a systematic review, these investigators examined the role of radiotherapy in this context. } 1998;49:215-234. 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. Brown MH, Weinberg M, Chong N, et al. No new trials were identified for this first update. 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. Principles of breast re-reduction: A reappraisal. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. 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). Collins ED, Kerrigan CL, Kim M, et al. Ann Plast Surg. Krieger LM, Lesavoy MA. 2015;49(6):363-366. Mizgala CL, MacKenzie KM. 1995;61(11):1001-1005. ul.ur li{ Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. However, these medications should be reserved for those with no decrease in breast size after 2 years. 2019;8(4):431-440. 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). Breast cancer found at the time of breast reduction. 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. 2008;53(3):255-261. 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. 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? Plastic Reconstr Surg. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). 2014b;48(5):334-339. 2015;75(4):383-387. No data were provided on loss to follow-up. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Collis N, McGuiness CM, Batchelor AG. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . 2nd ed. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. 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 Ann Plastic 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. Arlington Heights, IL: ASPS; March 9, 2002. American Society of Plastic Surgeons (ASPS). --> 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. padding-right: 18px; Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). 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. Karamanos et al (2015) identified their study as the largest sample on breast reduction in the literature, in which age and surgeon specialty did not correlate with negative results. Obesity and complications in breast reduction surgery: Are restrictions justified? Aetna considers breast reconstructive surgery to correct 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. Plast Reconstr Surg. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. J Plast Surg Hand Surg. 2004;113(1):436-437. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. .strikeThrough { 2008;121(4):1092-1100. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. 2007;356(5):479-485. Plastic Reconstruct Surg. of the following criteria must be met: Anesthesia may be injected along with saline solution until the tissue is firm, and a suction cannula is used to extract fat from the breast. Gynecomastia has been classified into2 types. This Clinical Policy Bulletin may be updated and therefore is subject to change. ASPS Recommended Coverage Criteria for Third Party Payors. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. Chadbourne EB, Zhang S, Gordon MJ, et al. 01/04/2023 /*margin-bottom: 43px;*/ Plast Reconstr Surg. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. 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. In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Abnormalities in Adolescent Breast Development. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Yao Y, Yang Y, Liu J, et al. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. No author listed. 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). Townsend: Sabiston Textbook of Surgery. 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. The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. Med Decis Making. ASPS clinical practice guideline summary on reduction mammaplasty. 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. Gynecomastia is a very common concern of male adolescence. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne skin should not be excised horizontally below the inframammary fold. 2014b;30(6):641-647. Plast Reconstr Surg. Also, there was no correlation between PR expression and 2D: 4D. High-risk lesions (atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], and lobular carcinoma in situ [LCIS]) were revealed in 37 (11.7 %), and cancer in 6 (1.9 %) patients. 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. Araco A, Gravante G, Araco F, et al. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. 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. } 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:. The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. Surgical treatment of primary gynecomastia in children and adolescents. Breast J. 2014;20(3):274-278. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. 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. Narula HS, Carlson HE. @media print { 1997;185(6):593-603. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. padding: 10px; Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Surgical implications of obesity. background: #5e9732; Leclere FM, Spies M, Gohritz A, Vogt PM. 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). For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Annu Rev Med. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Reduction mammaplasty provides long-term improvement in health status and quality of life. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. 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. 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). 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). li.bullet { Br J Plast Surg. Ann Plastic Surg. 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. Howrigan P. Reduction and augmentation mammoplasty. Schnur PL, Schnur DP, Petty PM, et al. Bertin ML, Crowe J, Gordon SM. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. 2002;33:208-217. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age.

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