.fixedHeaderWrap { Leclere FM, Spies M, Gohritz A, Vogt PM. 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. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. cursor: pointer; In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Reduction mammaplasty. The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). 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. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. Management of gestational gigantomastia. 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. 40 . 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. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. Ann Plastic Surg. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. 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. Grooving where the bra straps sit on the shoulder. Plastic surgery for teenagers briefing paper. 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. Breast cancer found at the time of 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. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. 2021;147(5):1072-1083. Plast Reconstr Surg. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. 2009;62(2):195-199. Surgical implications of obesity. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. All the patients recovered well and were satisfied with the cosmetic outcomes. 1998;49:215-234. 1997;100(4):875-883. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. There were only 2 studies of a total 25 patients that were considered as good in quality. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. 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. .newText { Plast Reconstr Surg. 1993;17(3):211-223. 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: 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. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Breast J. A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio). }. 2018;89(6):408-412. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. } Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Gynecomastia. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. padding-right: 18px; Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Treatment of adolescent gynecomastia. Arlington Heights, IL: ASPS; 2011. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). 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:. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Arch Dis Child. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Surgical treatment of gynecomastia: Complications and outcomes. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Resolution of idiopathic gynecomastia may take several months to years. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or Ann Plast Surg. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. height:2px; The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. 2007;119(4):1159-1166. A systematic search of the published literature was performed. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Emiroglu M, Salimoglu S, Karaali C, et al. 1990;24(1):61-67. Treating providers are solely responsible for medical advice and treatment of members. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Gynecomastia: Evolving paradigm of management and comparison of techniques. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Raispis T, Zehring RD, Downey DL. The health burden of breast hypertrophy. OL OL OL OL OL LI { Gland Surg. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. } Plast Reconstr Surg. Current concepts in gynaecomastia. Surg Laparosc Endosc Percutan Tech. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. list-style-type: upper-alpha; the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. 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. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. 1. 2008;121(4):1092-1100. background-position: right 65%; Surgical treatment of primary gynecomastia in children and adolescents. color: blue 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). This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. 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. Aesthet Plastic Surg. Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. 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 Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Burns JL, Blackwell SJ. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. No data were provided on loss to follow-up. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. --> Kerrigan CL, Collins ED, Kim HM, et al. American Society of Plastic Surgeons (ASPS). 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. Yao Y, Yang Y, Liu J, et al. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Well-designed clinical trials provide reliable information about the effectiveness of an intervention, and provide valid information about the characteristics of patients who would benefit from that intervention. ol.numberedList LI { 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. .newText { This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Brown DM, Young VL. This may lead to additional scarring and additional operating time. The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. The end-point was the complete resolution of gynecomastia. padding: 10px; 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. Reduction mammoplasty improves symptoms of macromastia. Plast Reconstr Surg. 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. Am Surg. padding-bottom: 4px; In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Reduction mammaplasty: Defining medical necessity. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Principles of breast re-reduction: A reappraisal. 2001;108(1):62-67. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne 1999;103(6):1687-1690. Qu S, Zhang W, Li S, et al. 2000;45(6):575-580. skin should not be excised horizontally below the inframammary fold. } Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Major complications (1.6 %) included unilateral hematoma and localized infection. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Breast hypertrophy. Patient demographics, surgical technique, and outcomes were analyzed. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. The characteristics of patients as well as the curative effects between the 2 groups were analyzed.
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