Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. 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). However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. N Engl J Med. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. font-size: 18px; Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Two review authors undertook independent data extraction of study characteristics, methodological quality and outcomes (e.g., infection, other wound complications, pain, and length of hospital stay [LOS]). The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. Risk of bias was assessed independently by 2review authors. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. A total of 244 out of 1,628 patients with the average age of 23.13 years. Subjects were compared to age-matched norms from another study cohort. } In other patients, excess skin and nipple and areola relocation are necessary. All the patients recovered well and were satisfied with the cosmetic outcomes. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. 1993;17(3):211-223. 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. Breast reduction for symptomatic macromastia. There were only 2 studies of a total 25 patients that were considered as good in quality. The primary outcome was the difference in wound drainage over 24 hours. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. However, these medications should be reserved for those with no decrease in breast size after 2 years. Surgical treatment of primary gynecomastia in children and adolescents. Follow-up ranged from 2 months to 3 years. Aetna considers breast reconstructive surgery to correct The Breast: Comprehensive Management of Benign and Malignant Diseases. The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. 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). 1990;24(1):61-67. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. Bland KI, Copeland EM, eds. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. 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. 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). Disproportionately large breasts can cause both physical and emotional . 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. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Tang CL, Brown MH, Levine R, et al. Li CC, Fu JP, Chang SC, et al. 2009;62(2):195-199. Kalliainen LK; ASPS Health Policy Committee. Gynecomastia: Evolving paradigm of management and comparison of techniques. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. No data were provided on loss to follow-up. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. 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. J Laparoendosc Adv Surg Tech A. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. 2001;107(5):1234-1240. Burdette TE, Kerrigan CL, Homa KA. display: none; 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]. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Gynecomastia has been classified into2 types. 2008;121(4):1092-1100. 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 No new trials were identified for this first update. list-style-type : square !important; #backTop:hover { Araco A, Gravante G, Araco F, et al. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Gynecomastia is a very common concern of male adolescence. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. 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. 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. 2018;89(6):408-412. Am J Infect Control. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. The study subjects were stratified into groups based on ages of <60 years and 60 years. }. A detailed physical examination, including testicular examination. Breast J. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. 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. Treating providers are solely responsible for medical advice and treatment of members. } Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Kerrigan CL, Collins ED, Kim HM, et al. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Mizgala CL, MacKenzie KM. 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: A systematic search of the published literature was performed. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. Fagerlund A, Lewin R, Rufolo G, et al. 2017;35:157-161. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Tang CL, Brown MH, Levine R, et al. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Plast Reconstr Surg. right: 30px; Major complications (1.6 %) included unilateral hematoma and localized infection. 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. Fischer S, Hirsch T, Hirche C, et al. of . .newText { Breast hypertrophy. background-color: #cc0066; breast augmentation with implant. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. ol.numberedList LI { Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 2011;128(4):243e-249e. Ann Plast Surg. While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . 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. Mayo Clin Proc. ASPS Recommended Coverage Criteria for Third Party Payors. 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. 2015;10(8):e0136094. color: #FFF; 01/04/2023 Fischer JP, Cleveland EC, Shang EK, et al. Ann Plast Surg. 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.
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