A population-level analysis of bilateral breast reduction: does age affect early complications? Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. No data were provided on loss to follow-up. list-style-type: lower-alpha; outline: none; A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. All patients underwent routine investigations to exclude secondary causes of gynecomastia. Reduction mammoplasty: Cosmetic or reconstructive procedure? Mistry RM, MacLennan SE, Hall-Findlay EJ. A total of 81 patients were included in this study. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. 2006;30(3):309-319. Hoyos AE, Perez ME, Dominguez-Millan R, et al. Breast hypertrophy. Grooving where the bra straps sit on the shoulder. 2020 Sep 4 [Online ahead of print]. bottom: 20px; A cohort study of breast cancer risk in breast reduction patients. All RCTs that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. J Am Coll Surg. 1995;95(1):77-83. .newText { For medical 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. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Sugrue CM, McInerney N, Joyce CW, et al. Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). Aesthetic Plast 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. A physician-supervised diet and exercise plan may be indicated in obese patients. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Breast. Laituri CA, Garey CL, Ostlie DJ, et al. Asian J Surg. Level of Evidence = IV. Chadbourne EB, Zhang S, Gordon MJ, et al. 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., breast size stable over one year) when any of the following criteria (A, B, or C) is met: Macromastia: all of the following criteria must be met: Breast pumps. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. These investigators searched the literature on the treatment of Simon's grade I and II gynecomastia in PubMed, Scopus, Science Direct, and Cochrane using keywords "gynecomastia" and "liposuction". World J Surg. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. 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). Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Plast Reconstr Surg. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. See Appendix for Table 1. Ann Plast Surg. 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. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Cochrane Database Syst Rev. 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. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. 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). Reduction mammaplasty: Defining medical necessity. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Kerrigan CL, Collins ED, Striplin D, et al. Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. 2000;106(5):991-997. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. 2014a;34(3):409-416. border: none; Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Breast J. Sabistons Textbook of Surgery (Burns & Blackwell, 2008)states that breast size should be stable for one year: There is no set lower age limit but, for the adolescent with breast hypertrophy, reduction is deferred until the breasts have stopped growing and are stable in size for at least 12 months before surgery.. (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. 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. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Reduction mammaplasty: The need for prospective randomized studies. Arch Dis Child. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. 2008;32(1):38-44. and areola. 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. 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. Breast reduction for symptomatic macromastia. Although the BRAVO study nominally included a "control group", there was no comparison group of subjects selected from the same cohort, who were randomized or otherwise appropriately assigned to reduce bias, and treated with conservative management according to a protocol to ensure optimal conservative care. 2012;69(5):510-515. 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. 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. 2001;107(5):1234-1240. 2010;45(3):650-654. } The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. 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. 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). Risk of bias was assessed independently by 2review authors. Plastic Reconstruct Surg. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. 2000;45(6):575-580. Raispis T, Zehring RD, Downey DL. Level of Evidence = IV. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Special Clinical Concerns. 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. 2000;44(2):125-134. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? When seeking preauthorization for a breast reduction, your goal is generally twofold. color:#eee; Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. 2017;35:157-161. 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. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Howrigan P. Reduction and augmentation mammoplasty. Ann Plast Surg. background-color: #663399; 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. Yao Y, Yang Y, Liu J, et al. Gland Surg. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. 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. A total of 244 out of 1,628 patients with the average age of 23.13 years. 2003;111(2):688-694. #closethis { } Flancbaum L, Choban PS. Setala L, Papp A, Joukainen S, et al. You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. 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). A follow-up study of 105 women with breast cancer following reduction mammaplasty. border-radius: 4px; All studies on the subject were evaluated for inclusion and 6 studies were included in the review. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). cursor: pointer; Miller AP, Zacher JB, Berggren RB, et al. Level of Evidence = III. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Breast and aesthetic surgery. 1. Ann Plast Surg. Leclere FM, Spies M, Gohritz A, Vogt PM. Refer to the member's specific plan document for applicable coverage. PLoS One. Quality of life after breast reduction. 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. 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. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Aesthetic Plast Surg. Policy. Another set of breast pump supplies if you get pregnant . Reduction mammoplasty: Criteria for insurance coverage. 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. And if you are in Canada the surgeon decides. Saunders Co.; 1991. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Three review authors undertook independent screening of the search results. 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). Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. 2011;128(4):243e-249e. Because reduction mammoplasty may be used for both medically necessary and cosmetic indications, Aetna has set forth above objective criteria to distinguish medically necessary reduction mammoplasty from cosmetic reduction mammoplasty. 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. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Plastic Reconstruct Surg. To get insurance coverage, you'll probably need . 2019;8(4):431-440. color: blue This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. @media print { position: fixed; 2009;19(3):e85-e90. } Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients.