The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . } No data were provided on loss to follow-up. He Q, Zheng L, Zhuang D, et al. Breast J. With approval from the authors institutional ethics committee and written informed consent, a total of 22 patients with 33 abnormally hyperplastic breasts were enrolled at the First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. 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. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). 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. 1. 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. Ann Plastic Surg. 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. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Hoyos AE, Perez ME, Dominguez-Millan R, et al. /* aetna.com standards styles for templates */ Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. 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. Obstet Gynecol Clin North Am. The majority (87.7 %) of cases presented with accompanying mastalgia. Burdette TE, Kerrigan CL, Homa KA. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. 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. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Blomqvist L, Eriksson A, Brandberg Y. .headerBar { of . There were no restrictions on the basis of date or language of publication. 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. 1996;20(5):391-397. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. A systematic search of the published literature was performed. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Gynecomastia in patients with prostate cancer: A systematic review. Plast Reconstr Surg. Ann Chir Plast Esthet. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Can objective predictors for operative success be identified? top: 0px; 2000;44(2):125-134. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. 1993;91(7):1270-1276. Ann Plast Surg. cursor: pointer; 2016;20(3):256-260. .strikeThrough { Plastic Reconstruct Surg. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Bland KI, Copeland EM, eds. Aesthetic Plast Surg. 2008;53(3):255-261. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. Coding Breast reduction for symptomatic macromastia. If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. 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. Obesity and complications in breast reduction surgery: Are restrictions justified? Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Refer to the member's specific plan document for applicable coverage. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. A total of 15 articles met the inclusion criteria for review. 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. Plast Reconstr Surg. 2009;7(2):114-119. .newText { padding: 10px; Fagerlund A, Cormio L, Palangi L, et al. Breast asymmetries: A brief review and our experience. background-color: #663399; Collins ED, Kerrigan CL, Kim M, et al. }. 2007;36(2):497-519. Plast Reconstr Surg. 2021 Aug 11 [Online ahead of print]. Management of gestational gigantomastia. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Reduction mammoplasty: Cosmetic or reconstructive procedure? 2019;8(4):431-440. 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. Variations in pattern of pubertal changes in girls. 1999;103(6):1687-1690. Surgical implications of obesity. 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.. Am J Infect Control. 2020 Sep 4 [Online ahead of print]. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. 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. 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. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Gynecomastia is a very common concern of male adolescence. 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. Reduction mammaplasty. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. A total of 244 out of 1,628 patients with the average age of 23.13 years. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass 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. Also, there was no correlation between PR expression and 2D: 4D. 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 Gynaecomastia. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). 2011;128(4):243e-249e. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. 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). Prostate Cancer Prostatic Dis. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Arlington Heights, IL: ASPRS; 1987. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. A non-standardized survey showed a very high satisfaction index. 2014b;30(6):641-647. 2017;139(6):1313-1322. Washington, DC: ACOG; 2011:121-122. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Sugrue CM, McInerney N, Joyce CW, et al. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. J Plast Surg Hand Surg. Aesthetic Plast Surg. Philadelphia, PA: W.B. No new trials were identified for this first update. 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. 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. Saunders Co.; 1991. background-color: #cc0066; 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. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . 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. 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. Quality of life after breast reduction. 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.
