Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Type II gynecomastia is more generalized breast enlargement. margin-top: 38px; 2021 Aug 11 [Online ahead of print]. The risks included infection, wound breakdown, scarring, and the need for re-operating. 2015;49(6):311-318. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. J Laparoendosc Adv Surg Tech A. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . All patients underwent routine investigations to exclude secondary causes of gynecomastia. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy. } Aesthetic Plast Surg. Current concepts in gynaecomastia. No other operation-related complications were observed. Wound drainage after plastic and reconstructive surgery of the breast. J Plast Surg Hand Surg. 1999;103(6):1682-1686. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. 2014a;34(1):66-73. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. 1995;95(1):77-83. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. 2009;19(3):e85-e90. 18th ed. padding: 10px; color:#eee; 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. Ann Plast Surg. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Abnormal histopathological findings were more frequent in patients with reduction mammoplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). There were only 2 studies of a total 25 patients that were considered as good in quality. Surgical treatment is indicated when medical treatments fail. color: #FFF; In other patients, excess skin and nipple and areola relocation are necessary. Prepubertal gynecomastia linked to lavender and tea tree oils. Oxfordshire NHS Trust. 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. color: white; Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Plast Reconstr Surg. Policy Statement 6d: Aesthetic surgery procedures. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. --> If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. A total of 15 articles met the inclusion criteria for review. Ann Chir Plast Esthet. A total of 81 patients were included in this study. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass The nipple-areola complex was re-positioned in 60 % of patients (n = 54). color: blue 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. 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. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Gynaecomastia. Principles of breast re-reduction: A reappraisal. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Br J Plast Surg. display: none; Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). 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. Hello! 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. Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Tang CL, Brown MH, Levine R, et al. Surgical treatment of primary gynecomastia in children and adolescents. } .fixedHeaderWrap { All studies on the subject were evaluated for inclusion and 6 studies were included in the review. 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. Schnur PL, Schnur DP, Petty PM, et al. Breast pumps. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. 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: list-style-type: upper-alpha; Arch Dis Child. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. A non-standardized survey showed a very high satisfaction index. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. } 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. Treating providers are solely responsible for medical advice and treatment of members. Tang CL, Brown MH, Levine R, et al. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. 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. 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. 01/04/2023 Glatt BS, Sarwer DB, O'Hara DE, et al. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review Plastic Reconstr Surg. 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. 1998;41(3):240-245. A cohort study of breast cancer risk in breast reduction patients. Plast Reconstr Surg. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). list-style-type: decimal; ul.ur li{ Gynecomastia. 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). z-index: 99; Hoyos AE, Perez ME, Dominguez-Millan R, et al. 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. 2011;128(4):243e-249e. Statistical analysis was performed with student t-test and chi-square test. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Plast Reconstr Surg. Plastic Reconstr Surg. ASPS clinical practice guideline summary on reduction mammaplasty. Many men with breast enlargement are found to have pseudo-gynecomastia. 1995;61(11):1001-1005. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. American Society of Plastic Surgeons (ASPS). Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. See Appendix for Table 1. Aesthetic Plast Surg. 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. 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. Asian J Surg. Breast reduction for symptomatic macromastia. Obesity and complications in breast reduction surgery: Are restrictions justified? In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. background-color:#eee; In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. } 2009;7(2):114-119. 1998;101(2):361-364. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . display: block; Women's Health and Cancer Rights Act of 1998. Reduction mammaplasty: Defining medical necessity. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. No data were provided on loss to follow-up. 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. Plast Reconstr Surg. Surg Laparosc Endosc Percutan Tech. Breast and aesthetic surgery. Please check your insurance policy to see whether breast reduction is a covered procedure. Breast cancer found at the time of breast reduction. In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). 2006;30(3):309-319. Araco A, Gravante G, Araco F, et al. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. These preliminary findings need to be validated by well-designed studies. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. 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). Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Qu S, Zhang W, Li S, et al. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. 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. Autorino R, Perdona S, D'Armiento M, et al. Pediatr Surg Int. Scand J Plast Reconstr Hand Surg. 2007;356(5):479-485. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). 2018;24(6):1043-1045. color: blue!important; # color: white; 2015;75(4):370-375. 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]. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Aesthetic Plast Surg. In a systematic review, these investigators examined the role of radiotherapy in this context. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Lonie S, Sachs R, Shen A, et al. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. 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. Administration of Benefits and Transition Responsibilities J Plast Surg Hand Surg. 1999;103(1):76-82; discussion 83-85. border-radius: 4px; Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Little is known about the effect of surgical treatment on the psychological aspects of the disease. 1991;27(3):232-237. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 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. 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). Plast Reconstr Surg. Brown MH, Weinberg M, Chong N, et al. 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). Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. 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). It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Howrigan P. Reduction and augmentation mammoplasty. 2017;139(6):1313-1322. Breast J. 2014b;48(5):334-339. 2 . Seitchik MW. 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%. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Reduction mammoplasty for asymptomatic members is considered cosmetic. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. position: fixed; Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Mayo Clin Proc. Devalia HL, Layer GT. 2012;69(5):510-515. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. 2005;58(3):286-289. Reduction mammoplasty for macromastia. 2010;45(3):650-654. li.bullet { The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Plast Reconstr Surg. cursor: pointer; Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Other just require 500 grams no matter what your height and weight. color: red!important; Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Bland KI, Copeland EM, eds. 1. background-color: #cc0066; Aesthet Plastic Surg. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. Townsend: Sabiston Textbook of Surgery. Krieger LM, Lesavoy MA. 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. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. list-style-type: lower-roman; Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. 1996;20(5):391-397. Ann Plast Surg. padding-bottom: 4px; Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. 2007;36(2):497-519. 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. 2008;61(5):493-502. Exposure to partners using estrogen containing vaginal creams; Cancer chemotherapy (alkylating agents, methotrexate, vinca alkaloids, imatinib, combination chemotherapy), Androgen receptor blockers - bicalutamide, 5 reductase inhibitors - finasteride, dutasteride, Angiotensin converting enzyme inhibitors (captopril, enalapril), Calcium channelblockers(diltiazem, nifedipine, verapamil), Anabolic steroids(e.g., in body builders). Gynecomastia may be drug-induced.