Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Ann Plast Surg. border-radius: 4px; Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. 2014a;34(3):409-416. 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. Am Surg. }. Arlington Heights, IL: ASPS; 2011. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. J Plast Surg Hand Surg. 2020 Sep 4 [Online ahead of print]. Prostate Cancer Prostatic Dis. 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). Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. color: #FFF; Level of Evidence = IV. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Coding Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Computed tomography scan of adrenal glands to identify adrenal lesions. In a systematic review, these investigators examined the role of radiotherapy in this context. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. background: #5e9732; 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. Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. list-style-type: upper-alpha; Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. border-width:0; Breast J. For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. No necrosis, systemic infection, or muscle paralysis was reported. 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. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. display: none; Macromastia: all . J Plast Surg Hand Surg. of . Ann Plast Surg. } 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. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Devalia HL, Layer GT. 2007;36(2):497-519. Ages ranged from 18 to 66 years. 1969;44(235):291-303. #backTop:hover { Gland Surg. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Plast Reconstr Surg. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. ul.ur li{ } Safran T, Abi-Rafeh J, Alabdulkarim A, et al. 1999;103(6):1674-1681. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. 18th ed. width: 100%; /*margin-bottom: 43px;*/ 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. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). 2019;8(4):431-440. color:#eee; Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. 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). Br J Plast Surg. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. } Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. American Society of Plastic Surgeons (ASPS). 2nd ed. Araco A, Gravante G, Araco F, et al. Reduction mammoplasty improves symptoms of macromastia. #closethis { } Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Ann Plastic Surg. cursor: pointer; 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. 2000;106(2):280-288. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. of the following criteria must be met: 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. Oxfordshire NHS Trust. position: fixed; Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). 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. Links to various non-Aetna sites are provided for your convenience only. Horm Res Paediatr. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. 1995;95(6):1029-1032. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. 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 . 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). Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years). Chadbourne EB, Zhang S, Gordon MJ, et al. All the patients recovered well and were satisfied with the cosmetic outcomes. Variations in pattern of pubertal changes in girls. The average age was 24.7 years (range of 18 to 47 years). The studies used to support the arguments for the medical necessity of breast reduction surgery are poorly controlled and therefore subject to a substantial risk of bias in the interpretation of results. Setala L, Papp A, Joukainen S, et al. PLoS One. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. 1995;95(1):77-83. Reduction mammaplasty: An outcome study. 01/04/2023 Major complications (1.6 %) included unilateral hematoma and localized infection. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. 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. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR.