Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. 2000;44(2):125-134. This may lead to additional scarring and additional operating time. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Plastic Reconstruct Surg. padding-right: 18px; Li CC, Fu JP, Chang SC, et al. Reduction mammoplasty improves symptoms of macromastia. Plast Reconstr Surg. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Coding Another set of breast pump supplies if you get pregnant . top: 0px; Plast Reconstr Surg. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Reduction mammaplasty. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. See Appendix for Table 1. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. Kerrigan CL, Collins ED, Striplin D, et al. A total of 90 patients underwent breast re-reduction surgery. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Aesthetic Plast Surg. background: #5e9732; Fischer JP, Cleveland EC, Shang EK, et al. 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). Plastic Reconstr Surg. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. 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). 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. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. 2002;33:208-217. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. Ann Plast Surg. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Mayo Clin Proc. This investigators stated that these studies should include data from older individuals affected by gynecomastia and utilize valid tools of psychological measurement in order to better quantify the effect; elderly patients affected by the disease have been over-looked in the current research; more data on this subject could improve the pre-operative evaluation of these patients and help identify the patients who will benefit from treatment. /*margin-bottom: 43px;*/ For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Schnur PL, Schnur DP, Petty PM, et al. Qu S, Zhang W, Li S, et al. padding: 10px; Level of Evidence = IV. The majority (87.7 %) of cases presented with accompanying mastalgia. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. 1999;103(6):1682-1686. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. Gland Surg. 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). } Ann Plast Surg. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. Reduction mammaplasty provides long-term improvement in health status and quality of life. Am J Infect Control. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Breast reduction outcome study. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. 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. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. 2018;7(Suppl 1):S70-S76. Ann Plast Surg. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). In: Townsend CM, Beuchamp RD, Evers BM, eds. Burdette TE, Kerrigan CL, Homa KA. list-style-type: upper-roman; Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. Plastic Reconstruct Surg. 2006;9(2):109-114. 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. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. margin-top: 38px; 2009;19(3):e85-e90. Refer to the member's specific plan document for applicable coverage. Often times, insurance company will dictate how much breast tissue to be removed. Breast asymmetries: A brief review and our experience. 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. Risk of bias was assessed independently by 2review authors. Ann Plastic Surg. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. background-color:#eee; 1. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Annu Rev Med. 2017;139(6):1313-1322. 1995;95(1):77-83. Gynecomastia. Please check your insurance policy to see whether breast reduction is a covered procedure. All patients underwent routine investigations to exclude secondary causes of gynecomastia. 2008;32(1):38-44. Surgical management of gynecomastia--a 10-year analysis. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. He Q, Zheng L, Zhuang D, et al. hr.separator { 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: This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. All the patients recovered well and were satisfied with the cosmetic outcomes. Reduction mammaplasty: Defining medical necessity. This will be computed based on your body area. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Cochrane Database Syst Rev. You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. 2021;147(5):1072-1083. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . } 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. Plast Reconstr Surg. 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. Level of Evidence = IV. In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). The end-point was the complete resolution of gynecomastia. outline: none; The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. 2021;74(11):3128-3140. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Treating providers are solely responsible for medical advice and treatment of members. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. 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. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. 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. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). list-style-type: decimal; Fischer S, Hirsch T, Hirche C, et al. Computed tomography scan of adrenal glands to identify adrenal lesions. Many men with breast enlargement are found to have pseudo-gynecomastia. Plast Reconstr Surg. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. text-decoration: underline; Breast and aesthetic surgery. and areola. J Plast Reconstr Aesthet Surg. .arrowPurpleSmall, a:hover.arrowPurpleSmall { Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Resolution of idiopathic gynecomastia may take several months to years. 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". Hello! 1998;41(3):240-245. For medical Kerrigan CL, Collins ED, Kneeland TS, et al. This Clinical Policy Bulletin may be updated and therefore is subject to change. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Med Decis Making. A physician-supervised diet and exercise plan may be indicated in obese patients. 2018;24(6):1043-1045. Oxford, UK: National Health Service (NHS); October 2008. Last Review01/04/2023. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. Tang CL, Brown MH, Levine R, et al. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 18th ed. Major complications (1.6 %) included unilateral hematoma and localized infection. Obesity and complications in breast reduction surgery: Are restrictions justified? 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 NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). color: red!important; OL LI { The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. 2001;108(1):62-67. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. A total of 182 thirty-day postoperative surgical complications were documented, but stratifying patients into 2 age groups did not reveal an association between age and any surgical complication (P = .26). Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. 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]). Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Petty PM, Solomon M, Buchel EW, Tran NV. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. } Disproportionately large breasts can cause both physical and emotional . Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? 2000;106(5):991-997. color: #FFF; 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. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Surgeon. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. } color: red The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). # color: white; Flancbaum L, Choban PS. 2000;106(2):280-288. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. A total of 244 out of 1,628 patients with the average age of 23.13 years. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. 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 Plastic surgery for teenagers briefing paper. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Tang CL, Brown MH, Levine R, et al. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Plast Reconstr Surg. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Mistry RM, MacLennan SE, Hall-Findlay EJ. Plast Reconstr Surg. Treatment of adolescent gynecomastia. Townsend: Sabiston Textbook of Surgery. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Breast pumps. Gynecomastia in patients with prostate cancer: Update on treatment options. Arlington Heights, IL: ASPS; 2011. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 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. Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. ul.ur li{ In these cases, breast reduction for men may take 2 to 3 hours. 1998;49:215-234. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. The Breast: Comprehensive Management of Benign and Malignant Diseases. Ann Chir Plast Esthet. 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. Reduction mammoplasty for macromastia. Reduction mammoplasty: Criteria for insurance coverage. 2014b;30(6):641-647. 2006;30(3):309-319. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. 1999;103(6):1687-1690. 2015;(10):CD007258. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. 2015;49(6):363-366. Bertin ML, Crowe J, Gordon SM. J Plast Reconstr Aesthet Surg. 1997;185(6):593-603. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Evidence-based clinical practice guideline: Reduction mammaplasty. 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. 2008;53(3):255-261. text-decoration: line-through; 1995;61(11):1001-1005. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 2003;111(2):688-694. American Society of Plastic Surgeons (ASPS). Ann Plast Surg. 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. } 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. J Plast Reconstr Aesthet Surg. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. 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. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Second, it is the burden of the proponent of an intervention to provide reliable evidence of its effectiveness, not the burden of ones whoquestion the effectivenessan intervention to provide definitive proof of ineffectiveness. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Plast Reconstr Surg. Aesthet Plastic Surg. Current concepts in gynaecomastia. The primary outcome was the difference in wound drainage over 24 hours. Schnur PL, Hoehn JG, Ilstrup DM, et al. 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. 2018;89(6):408-412. width: 100%; Study subjects included 3538 patients with an average age of 43 years and body mass index of 31.6 kg/m(2) and most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes.The incidence of overall surgical complications was 5.1% and the incidence of major surgical complications was 2.1%. A total of 15 articles met the inclusion criteria for review. Oxfordshire NHS Trust. For individuals who received radiation treatment to the chest . Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. 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. 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. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. margin-bottom: 38px; Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Lonie S, Sachs R, Shen A, et al. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. American Society of Plastic Surgeons (ASPS). The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg.
Ohio Attorney General Offset,
Tongan Royal Family Killed,
Kroger Spring Water Tastes Bad,
Articles A