All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). 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. There were 18 out of 415 studies eligible to review. World J Surg. 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". width: 100%; Ann Plastic Surg. 2017;139(6):1313-1322. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Patient demographics, surgical technique, and outcomes were analyzed. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. 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. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. 2000;44(2):125-134. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Prostate Cancer Prostatic Dis. This Clinical Policy Bulletin may be updated and therefore is subject to change. The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. J Plast Reconstr Aesthet Surg. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Copyright Aetna Inc. All rights reserved. cursor: pointer; 2009;19(3):e85-e90. Grooving where the bra straps sit on the shoulder. skin should not be excised horizontally below the inframammary fold. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. 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. Mayo Clin Proc. Reduction mammoplasty: Criteria for insurance coverage. There were only 2 studies of a total 25 patients that were considered as good in quality. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Oxford, UK: National Health Service (NHS); October 2008. padding-right: 18px; ASPS clinical practice guideline summary on reduction mammaplasty. 2021 Aug 11 [Online ahead of print]. Marshall WA, Tanner JM. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. list-style-type: upper-alpha; Ann Chir Plast Esthet. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. 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). CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Surgical treatment of primary gynecomastia in children and adolescents. Breast Concerns of Adolescents. 2003;111(2):688-694. Type II gynecomastia is more generalized breast enlargement. Obesity and complications in breast reduction surgery: Are restrictions justified? 2002;33:208-217. Computed tomography scan of adrenal glands to identify adrenal lesions. Arlington Heights, IL: ASPS; May 2011. 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. border-width:0; padding: 10px; list-style-type: lower-roman; Risk of bias was assessed independently by 2review authors. 2000;45(6):575-580. 2007;119(4):1159-1166. 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). Current concepts in gynaecomastia. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. Plast Reconstr 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. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Three review authors undertook independent screening of the search results. While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. cursor: pointer; 1997;100(4):875-883. OL OL OL OL OL LI { Khan SM, Smeulders MJ, Van der Horst CM. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. 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. Setala L, Papp A, Joukainen S, et al. Aesthet Plastic Surg. 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. 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 . Leclere FM, Spies M, Gohritz A, Vogt PM. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Plastic Reconstr Surg. } In these cases, breast reduction for men may take 2 to 3 hours. ul.ur li{ 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. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. 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. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Level of Evidence = IV. height:2px; 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. Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). All the patients recovered well and were satisfied with the cosmetic outcomes. 2000;106(5):991-997. color: blue!important; Reduction mammaplasty: Defining medical necessity. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. 2007;36(2):497-519. 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. Nguyen JT, Wheatley MJ, Schnur PL, et al. Mizgala CL, MacKenzie KM. Collins ED, Kerrigan CL, Kim M, et al. This may lead to additional scarring and additional operating time. Ann Plast Surg. color: red For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. # color: white; The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Plastic Reconstruct Surg. He Q, Zheng L, Zhuang D, et al. } The average age was 24.7 years (range of 18 to 47 years). Surg Laparosc Endosc Percutan Tech. Measuring health state preferences in women with breast hypertrophy. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. J Plast Surg Hand Surg. Special Clinical Concerns. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Plast 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 2001;108(6):1591-1599. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Reduction mammaplasty: A review of managed care medical policy coverage criteria. In a systematic review, these investigators examined the role of radiotherapy in this context. Refer to the member's specific plan document for applicable coverage. Plast Reconstr Surg. Fischer S, Hirsch T, Hirche C, et al. The study subjects were stratified into groups based on ages of <60 years and 60 years. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. 01/04/2023 Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). Sood R, Mount DL, Coleman JJ 3rd, et al. 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. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Philadelphia, PA: W.B. Breast cancer found at the time of breast reduction. OL LI { Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Reduction mammoplasty for macromastia. However, these medications should be reserved for those with no decrease in breast size after 2 years. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Mistry RM, MacLennan SE, Hall-Findlay EJ. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. 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. Sugrue CM, McInerney N, Joyce CW, et al. Many men with breast enlargement are found to have pseudo-gynecomastia. 1995;34(2):113-116. 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. Treating providers are solely responsible for medical advice and treatment of members. Resolution of idiopathic gynecomastia may take several months to years. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Fischer JP, Cleveland EC, Shang EK, et al. A physician-supervised diet and exercise plan may be indicated in obese patients. Gynecomastia may be drug-induced. A follow-up study of 105 women with breast cancer following reduction mammaplasty. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Collis N, McGuiness CM, Batchelor AG. #closethis { A detailed physical examination, including testicular examination. The Breast: Comprehensive Management of Benign and Malignant Diseases. Also, there was no correlation between PR expression and 2D: 4D. } 2015;(10):CD007258. 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. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Breast hypertrophy. Pediatr Surg Int. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. 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. However, it is unclear if there is any evidence to support this practice. Treatment of adolescent gynecomastia. 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. Ann Plast Surg. Major complications (1.6 %) included unilateral hematoma and localized infection. Gynaecomastia. 1997;185(6):593-603. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. margin-bottom: 38px; Kasielska-Trojan A, Danilewicz M, Antoszewski B. 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%. 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. Quality of life after breast reduction. No author listed. Plast Reconstr Surg. Aesthetic Plast 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. 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.
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