A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. 2003;111(2):688-694. Hoyos AE, Perez ME, Dominguez-Millan R, et al. Variations in pattern of pubertal changes in girls. American Society of Plastic Surgeons (ASPS). Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. 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. The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 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. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. 1998;41(3):240-245. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. li.bullet { 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. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. 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]). Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Plast Reconstr Surg. Philadelphia, PA: W.B. A total of 15 articles met the inclusion criteria for review. padding: 15px; 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. Surg Laparosc Endosc Percutan Tech. American Society of Plastic Surgeons (ASPS). 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). Krieger LM, Lesavoy MA. 2021;74(11):3128-3140. of the following criteria must be met: 2002;109(5):1556-1566. The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. 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. Macromastia: all . Women's Health and Cancer Rights Act of 1998. 2014a;34(1):66-73. Arlington Heights, IL: ASPS; March 9, 2002. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. In the case of breast reduction, however, for insurance purposes, it . Major complications (1.6 %) included unilateral hematoma and localized infection. Follow-up ranged from 2 months to 3 years. 1999;103(6):1687-1690. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Often times, insurance company will dictate how much breast tissue to be removed. Subjects were compared to age-matched norms from another study cohort. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. Townsend: Sabiston Textbook of Surgery. Gynecomastia: A systematic review. 2019;8(4):431-440. Plast Reconstr Surg. 2001;76(5):503-510. background-color: #cc0066; 1991;27(3):232-237. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. 1999;103(6):1674-1681. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Plast Reconstr Surg. 2015;75(4):370-375. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. 1996;20(5):391-397. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Surgical treatment of gynecomastia: Complications and outcomes. Chadbourne EB, Zhang S, Gordon MJ, et al. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Narula HS, Carlson HE. 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. 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). Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Breast J. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 2006;9(2):109-114. Arlington Heights, IL: ASPS; 2011. Breast reduction outcome study. 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. The average age was 24.7 years (range of 18 to 47 years). OL OL OL OL OL LI { The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. When seeking preauthorization for a breast reduction, your goal is generally twofold. Three review authors undertook independent screening of the search results. Priorities Forum Policy Statement. Emiroglu M, Salimoglu S, Karaali C, et al. color: red Plast Reconstr Surg. J Laparoendosc Adv Surg Tech A. Bland KI, Copeland EM, eds. To get insurance coverage, you'll probably need . For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. 2001;107(5):1234-1240. margin-bottom: 38px; However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Aesthetic Plast Surg. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. breast augmentation with implant. 2007;36(2):497-519. 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. 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. Med Decis Making. American Society of Plastic and Reconstructive Surgery (ASPRS). J Plast Reconstr Aesthet Surg. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. All the patients recovered well and were satisfied with the cosmetic outcomes. 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. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. OL OL OL LI { .headerBar { Note: Chronic intertrigo, eczema, dermatitis, and/or ulceration in the infra-mammary fold in and of themselves are not considered medically necessary indications for reduction mammoplasty. Ages ranged from 18 to 66 years. margin-top: 38px; Computed tomography scan of adrenal glands to identify adrenal lesions. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. 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. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Plast Reconstr Surg. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. In addition, Nguyen et al (2004) ignored a wealth of published evidence of the effectiveness of physical therapy, analgesics and other conservative measures on back and neck pain generally. Based on CPB criteria and the information we have, we're denying coverage for breast reduction 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. Howrigan P. Reduction and augmentation mammoplasty. A total of 90 patients underwent breast re-reduction surgery. 2017;35:157-161. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Please check your insurance policy to see whether breast reduction is a covered procedure. Obstet Gynecol Clin North Am. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Reduction mammoplasty for macromastia. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Scand J Plast Reconstr Hand Surg. A cohort study of breast cancer risk in breast reduction patients. 2008;121(4):1092-1100. 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. This may lead to additional scarring and additional operating time. Aetna considers breast reconstructive surgery to correct 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. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Breast J. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Breast reduction for symptomatic macromastia. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection].

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