The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Breast Concerns of Adolescents. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 2011;128(4):243e-249e. Surgical management of gynecomastia--a 10-year analysis. The risks included infection, wound breakdown, scarring, and the need for re-operating. The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Arlington Heights, IL: ASPS; 2011. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. 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). Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. Mistry RM, MacLennan SE, Hall-Findlay EJ. Tang CL, Brown MH, Levine R, et al. A detailed physical examination, including testicular examination. 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. 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. Fagerlund A, Lewin R, Rufolo G, et al. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Evidence-based clinical practice guideline: Reduction mammaplasty. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. 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. 2000;106(5):991-997. outline: none; 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. OL OL LI { OL OL OL LI { The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. 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). #closethis { Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. 2nd ed. Gynecomastia has been classified into2 types. 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. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Am J Infect Control. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). 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). Qu S, Zhang W, Li S, et al. } Aesthetic Plast Surg. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . Surgical treatment of gynecomastia: Complications and outcomes. } For medical 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. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). A systematic search of the published literature was performed. Ann Plast Surg. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Philadelphia, PA: W.B. Plast Reconstr Surg. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Glatt BS, Sarwer DB, O'Hara DE, et al. J Plast Surg Hand Surg. Follow-up ranged from 2 months to 3 years. The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. 1995;95(1):77-83. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Fagerlund A, Cormio L, Palangi L, et al. Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Resolution of idiopathic gynecomastia may take several months to years. Burns JL, Blackwell SJ. Schnur PL, Schnur DP, Petty PM, et al. Reduction mammaplasty. Reduction mammaplasty: An outcome study. When seeking preauthorization for a breast reduction, your goal is generally twofold. Well-designed trials are especially important in assessing pain management interventions to isolate the contribution of the intervention from placebo effects, the effects of other concurrently administered pain management interventions, and the natural history of the medical condition. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Cochrane Database Syst Rev. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Surgery. 2002;109(5):1556-1566. 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. 2018;7(Suppl 1):S70-S76. In: Townsend CM, Beuchamp RD, Evers BM, eds. Gynecomastia: A systematic review. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Nelson et al (2014b) separately conducted a population level analysis of the 2005-2011 NSQIP datasets, identifying patient who underwent reduction mammoplasty, to determine the impact of obesity on early complications after reduction mammoplasty. 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. 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. 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 Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. display: none; Ann Plast Surg. Reduction mammaplasty provides long-term improvement in health status and quality of life. Petty PM, Solomon M, Buchel EW, Tran NV. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. /*margin-bottom: 43px;*/ margin-top: 38px; 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. Recommended criteria for insurance coverage of reduction mammoplasty. 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. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. 1. } 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. 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. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. 18th ed. Hoyos AE, Perez ME, Dominguez-Millan R, et al. 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. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Thus, more than 1/3of operative subjects selected for inclusion in the study did not complete it; most of the operative subjects who did not complete the study were lost to follow-up. Arch Dis Child. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Flancbaum L, Choban PS. Plast Reconstr Surg. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . 2015;75(4):370-375. J Plast Surg Hand Surg. 2005;58(3):286-289. Breast reduction for symptomatic macromastia. This will be computed based on your body area. Aesthet Surg J. A total of 15 articles met the inclusion criteria for review. No author listed. Aesthet Surg J. 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. Many men with breast enlargement are found to have pseudo-gynecomastia. Level of Evidence = IV. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Washington, DC: ACOG; 2011:121-122. 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. 2015;(10):CD007258. Reduction mammoplasty for macromastia. } J Laparoendosc Adv Surg Tech A. In these cases, breast reduction for men may take 2 to 3 hours. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. display: block; However, it is unclear if there is any evidence to support this practice. Narula HS, Carlson HE. Fischer S, Hirsch T, Hirche C, et al. Gynecomastia in patients with prostate cancer: A systematic review. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. A total of 81 patients were included in this study. Prepubertal gynecomastia linked to lavender and tea tree oils. 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. Tang CL, Brown MH, Levine R, et al. of the following criteria must be met: GP Notebook. A total of 90 patients underwent breast re-reduction surgery. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. 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 authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). All patients underwent routine investigations to exclude secondary causes of gynecomastia. 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. padding-bottom: 4px; 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. 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). padding: 10px; bottom: 20px; } 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%. Brown DM, Young VL. 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]. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. No other operation-related complications were observed. The primary outcome was the difference in wound drainage over 24 hours. 1998;26(1):61-65. 2010;45(3):650-654. 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. There were no restrictions on the basis of date or language of publication. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in 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. 1998;41(3):240-245. 1993;17(3):211-223. OL LI { Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. 2009;19(3):e85-e90. 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). 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. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Plastic Reconstr Surg. 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 J Plast Reconstr Aesthet Surg. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. The health burden of breast hypertrophy. 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. Plast Reconstr Surg. Also, there was no correlation between PR expression and 2D: 4D. 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. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. 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.

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