These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Fagerlund A, Lewin R, Rufolo G, et al. 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). Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years). The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. Araco A, Gravante G, Araco F, et al. Reduction mammaplasty: The need for prospective randomized studies. Blomqvist L, Eriksson A, Brandberg Y. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. 2015;49(6):311-318. Follow-up ranged from 2 months to 3 years. Collins ED, Kerrigan CL, Kim M, et al. 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. Ann Plastic Surg. 2008;61(5):493-502. 2001;76(5):503-510. 1998;49:215-234. list-style-type: lower-roman; Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Statistical analysis was performed with student t-test and chi-square test. color: white; breast augmentation with implant. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Can objective predictors for operative success be identified? Aesthetic Plast Surg. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Prepubertal gynecomastia linked to lavender and tea tree oils. Plast Reconstr Surg. Little is known about the effect of surgical treatment on the psychological aspects of the disease. 2011;128(4):243e-249e. 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. Reduction mammaplasty. OL OL OL OL OL LI { 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. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Variations in pattern of pubertal changes in girls. --> The characteristics of patients as well as the curative effects between the 2 groups were analyzed. See Appendix for Table 1. A non-standardized survey showed a very high satisfaction index. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Ann Plast Surg. 1997;185(6):593-603. Risk factors for complications following breast reduction: Results from a randomized control trial. Reduction mammaplasty: Defining medical necessity. Hello! J Plast Reconstr Aesthet Surg. 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. Guidelines for Adolescent Health Care. 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: The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. ol.numberedList LI { Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. The authorsleave the reader with the conclusionthat decisions about the medical necessity of breast reduction surgery in symptomatic women should be left entirely to the surgeon's discretion. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Breast Concerns of Adolescents. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. N Engl J Med. 2000;106(5):991-997. } Ann Plastic Surg. 2nd ed. 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 authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. 2014b;30(6):641-647. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Arlington Heights, IL: ASPS; 2011. 2000;106(2):280-288. 2003;111(2):688-694. text-decoration: line-through; Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. A follow-up study of 105 women with breast cancer following reduction mammaplasty. Aesthetic Plast Surg. position: fixed; You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. Tang CL, Brown MH, Levine 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). Gynaecomastia. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; border: none; Policy Statement 6d: Aesthetic surgery procedures. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. However, these medications should be reserved for those with no decrease in breast size after 2 years. 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. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . } Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. J Plast Surg Hand Surg. When seeking preauthorization for a breast reduction, your goal is generally twofold. Reduction mammoplasty: Criteria for insurance coverage. 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: padding: 15px; Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Med Decis Making. .strikeThrough { 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). Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Oxfordshire NHS Trust. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). Horm Res Paediatr. 2006;9(2):109-114. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. 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. Mizgala CL, MacKenzie KM. Kasielska-Trojan A, Danilewicz M, Antoszewski B. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. No new trials were identified for this first update. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Plast Reconstr Surg. Level of Evidence = IV. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). /*margin-bottom: 43px;*/ In: Townsend CM, Beuchamp RD, Evers BM, eds. Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. color: blue Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. 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. Aesthet Surg J. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. list-style-type: upper-roman; 1998;41(3):240-245. Determinants of surgical site infection after breast surgery. Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. Coding 1999;103(6):1682-1686. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). For individuals who received radiation treatment to the chest . A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Subjects were compared to age-matched norms from another study cohort. A cohort study of breast cancer risk in breast reduction patients. 1. 2019;166(5):934-939. Often times, insurance company will dictate how much breast tissue to be removed. Grooving where the bra straps sit on the shoulder. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. 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.. J Plast Surg Hand Surg. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. 2002;109(5):1556-1566. Surgeon. 2006;118(4):840-848. The primary outcome was the difference in wound drainage over 24 hours. 2005;55(3):227-231. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) 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. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review Links to various non-Aetna sites are provided for your convenience only. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. This may lead to additional scarring and additional operating time. Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. 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). The majority (87.7 %) of cases presented with accompanying mastalgia. # font-weight: bold; Tang CL, Brown MH, Levine R, et al. And if you are in Canada the surgeon decides. Plast Reconstr Surg. 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. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Analysis was on an intention-to-treat basis. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. 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. For many patients the psychological impact of the disease is substantial. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. 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).

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