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. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. 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). Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. } Surgical treatment of primary gynecomastia in children and adolescents. Howrigan P. Reduction and augmentation mammoplasty. 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. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Ann Plast Surg. Reduction mammoplasty: Criteria for insurance coverage. Abnormalities in Adolescent Breast Development. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. 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. padding: 15px; Two review authors undertook independent data extraction of study characteristics, methodological quality and outcomes (e.g., infection, other wound complications, pain, and length of hospital stay [LOS]). In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. 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. 2013;71(5):471-475. Plast Reconstr Surg. Reduction mammoplasty for macromastia. Sood R, Mount DL, Coleman JJ 3rd, et al. Plast Reconstr Surg. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Plast 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). They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. Glatt BS, Sarwer DB, O'Hara DE, et al. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. --> 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? Links to various non-Aetna sites are provided for your convenience only. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Aesthetic Plast Surg. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. Refer to the member's specific plan document for applicable coverage. Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast. display: block; These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). To get insurance coverage, you'll probably need . 1999;103(1):76-82; discussion 83-85. #backTop:hover { Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. What are Aetna breast reduction requirements? - RealSelf.com Level of Evidence = IV. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Does Blue Cross Blue Shield Cover Breast Reduction Surgery? - HelpAdvisor However, these medications should be reserved for those with no decrease in breast size after 2 years. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. 2000;44(2):125-134. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. 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.. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Analysis was on an intention-to-treat basis. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Computed tomography scan of adrenal glands to identify adrenal lesions. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Reduction mammoplasty for asymptomatic members is considered cosmetic. Ann Plast Surg. Surgical treatment is indicated when medical treatments fail. World J Surg. 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). Setala L, Papp A, Joukainen S, et al. The mean age was 42.8 years (SD 19.5 years). American Society of Plastic Surgeons (ASPS). The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. 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. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. PDF Breast Reduction Surgery and Gynecomastia Surgery - Aetna Plastic Reconstruct Surg. Endocrinol Metab Clin North Am. 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. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. outline: none; Plast Reconstr Surg. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Level of Evidence = IV. Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. cursor: pointer; Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. 1999;103(6):1674-1681. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Gynaecomastia. Plast Reconstr Surg. Copyright Aetna Inc. All rights reserved. These preliminary findings need to be validated by well-designed studies. Hello! 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. ASPS clinical practice guideline summary on reduction mammaplasty. background-color: #663399; Med Decis Making. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. 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). 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. Breast Concerns of Adolescents. 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. Ann Plast Surg. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 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). Also, there was no correlation between PR expression and 2D: 4D. Plast Reconstr Surg. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. 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: Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Resolution of idiopathic gynecomastia may take several months to years. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. The health burden of breast hypertrophy. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. } Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. No author listed. .newText { 2008;32(1):38-44. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? 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. Fischer JP, Cleveland EC, Shang EK, et al. Yao Y, Yang Y, Liu J, et al. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Wound drainage after plastic and reconstructive surgery of the breast. Chadbourne EB, Zhang S, Gordon MJ, et al. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. The study subjects were stratified into groups based on ages of <60 years and 60 years. 2012;130(4):785-789. 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. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Plast Reconstr Surg. PLoS One. 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. Fagerlund A, Lewin R, Rufolo G, 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. Is breast reduction covered by health insurance? | ASPS Aesthetic Plast Surg. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. Cochrane Database Syst Rev. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Breast J. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Breast pumps. 2014;20(3):274-278. Plast Reconstr Surg. 2007;356(5):479-485. z-index: 99; The authors reach the remarkable conclusion that a woman with normal sized breasts who has only a few ounces of breast tissue removed is as likely to receive as much benefit from breast reduction surgery as a women with large breasts who has substantially more breast tissue removed. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. A cohort study of breast cancer risk in breast reduction patients. Measuring health state preferences in women with breast hypertrophy. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Principles of breast re-reduction: A reappraisal. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. All patients underwent routine investigations to exclude secondary causes of gynecomastia. 2002;109(5):1556-1566. Emiroglu M, Salimoglu S, Karaali C, et al. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. 2010;45(3):650-654. } J Plast Reconstr Aesthet Surg. Plastic Reconstr Surg. OL OL OL OL OL LI { Can objective predictors for operative success be identified? 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. 2016;20(3):256-260. How to Get Your Breast Reduction Covered By Insurance - RealSelf News text-decoration: underline; The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. 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). 01/04/2023 Mental health care professionals may be consulted to address psychological distress from gynecomastia. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Khan SM, Smeulders MJ, Van der Horst CM. 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. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. breast augmentation with implant. 1994;21(3):539-543. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. and areola. 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.