1998;41(3):240-245. With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an out-patient; however, this was not statistically significant (p = 0.07). Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. } A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammoplasty regarding physical symptoms and body image. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. color: #FFF; It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Major complications (1.6 %) included unilateral hematoma and localized infection. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. 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). .strikeThrough { Ann Plast Surg. 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. PLoS One. 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. Krieger LM, Lesavoy MA. 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: 2000;44(2):125-134. OL OL OL OL LI { Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). In: Townsend CM, Beuchamp RD, Evers BM, eds. 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. 2001;108(6):1591-1599. 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. Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. 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. } 1996;20(5):391-397. 2015;75(4):383-387. 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. Surgical implications of obesity. The condition not only must be unresponsive to dermatological treatments (e.g., antibiotics or antifungal therapy) and conservative measures (e.g., good skin hygiene, adequate nutrition) for a period of 6 months or longer, but also must satisfy criteria stated insection I above. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. 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. 2007;119(4):1159-1166. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). 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. 2008;53(3):255-261. However, these medications should be reserved for those with no decrease in breast size after 2 years. Follow-up ranged from 2 months to 3 years. 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. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. 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 Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. This may lead to additional scarring and additional operating time. --> 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. 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. In this study the National Surgical Quality Improvement Program data set was queried for the Current Procedural Terminology code 19318 from the years 2005 to 2010, with principal outcome measurements of wound complications, surgical site infections, and reoperations. Khan SM, Smeulders MJ, Van der Horst CM. Gynecomastia. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. } For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. .newText { Quality of life after breast reduction. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Am Surg. } In a review on Surgical treatment of primary gynecomastia in children and adolescents, Fischer et al (2014b) concluded that surgical correction of gynecomastia remains a purely elective intervention. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Breast J. Surgical treatment of gynecomastia: Complications and outcomes. A total of 244 out of 1,628 patients with the average age of 23.13 years. There were no restrictions on the basis of date or language of publication. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Li CC, Fu JP, Chang SC, et al. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Mayo Clin Proc. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 2014b;48(5):334-339. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Plast Reconstr Surg. Arlington Heights, IL: ASPS; 2011. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. 2013;71(5):471-475. Measuring health state preferences in women with breast hypertrophy. Operative subjects who completed the study reported reductions in pain and improvements in quality of life; however, these improvements may be attributable to placebo effects, the natural history of back pain, other concurrent interventions, regression to the mean, improvements in cosmesis (for quality of life measures), or other confounding variables that may bias in interpretation of results. American Society of Plastic Surgeons (ASPS). 2000;106(2):280-288. Philadelphia, PA: W.B. They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. Evidence-based clinical practice guideline: Reduction mammaplasty. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 1995;95(6):1029-1032. 2001;76(5):503-510. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. Burdette TE, Kerrigan CL, Homa KA. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). Ages ranged from 18 to 66 years. Little is known about the effect of surgical treatment on the psychological aspects of the disease. 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). 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). } American Society of Plastic Surgeons (ASPS). 2014a;34(3):409-416. Fischer JP, Cleveland EC, Shang EK, et al. Ann Plast Surg. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. breast augmentation with implant. 2008;121(4):1092-1100. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. of the following criteria must be met: Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. The mean age was 42.8 years (SD 19.5 years). color: blue!important; Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. 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). Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. There were 18 out of 415 studies eligible to review. Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. 2014;20(3):274-278. # font-weight: bold; Karamanos et al (2015) identified their study as the largest sample on breast reduction in the literature, in which age and surgeon specialty did not correlate with negative results. J Plast Surg Hand Surg. Breast reduction outcome study. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Kerrigan CL, Collins ED, Striplin D, et al. Miller AP, Zacher JB, Berggren RB, et al. background-position: right 65%; Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. 2021;147(5):1072-1083. Annu Rev Med. Plast Reconstr Surg. Reduction mammaplasty: A review of managed care medical policy coverage criteria. 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%. 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 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. 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. Sugrue CM, McInerney N, Joyce CW, et al. Plastic Reconstruct Surg. 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. 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). 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: If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. /* aetna.com standards styles for templates */ } The author concluded that the current level of evidence on this subject was very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. margin-bottom: 38px; The end-point was the complete resolution of gynecomastia. 2015;(10):CD007258. Bland KI, Copeland EM, eds. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Leclere FM, Spies M, Gohritz A, Vogt PM. Macromastia: all . Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). The majority (87.7 %) of cases presented with accompanying mastalgia. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Reduction mammoplasty for macromastia. Ann Chir Plast Esthet. z-index: 99; list-style-type: lower-roman; skin should not be excised horizontally below the inframammary fold. Mizgala CL, MacKenzie KM. They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Level of Evidence = IV. A systematic search of the published literature was performed. Breast pumps. The member has gigantomastia of pregnancy accompanied byany of the following complications, and delivery is not imminent: For medical necessity criteria for surgery to correct breast asymmetry, seeCPB 0185 - Breast Reconstructive Surgery. Plast Reconstr Surg. 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). Gynaecomastia. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. 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". 2018;7(Suppl 1):S70-S76. Cochrane Database Syst Rev. 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. Determinants of surgical site infection after breast surgery. } Gynecomastia has been classified into2 types. A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio). See Appendix for Table 1. 1998;49:215-234. Araco A, Gravante G, Araco F, et al. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Breast J. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. 01/04/2023 Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. 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. Refer to the member's specific plan document for applicable coverage. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Principles of breast re-reduction: A reappraisal. 2015;75(4):370-375. 2004;113(1):436-437. 2008;32(1):38-44. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. li.bullet { Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Kerrigan CL, Collins ED, Kim HM, et al. 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. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Policy. 2006;30(3):309-319. 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. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 2001;107(5):1234-1240. Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . Bertin ML, Crowe J, Gordon SM. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). 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. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. The study subjects were stratified into groups based on ages of <60 years and 60 years. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. American Society of Plastic and Reconstructive Surgery (ASPRS). Burns JL, Blackwell SJ. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Ann Plast Surg.
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