2 . 2021;147(5):1072-1083. Arlington Heights, IL: ASPS; May 2011. Surgical management of gynecomastia--a 10-year analysis. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. ul.ur li{ 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). Ann Plast Surg. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Plast Reconstr Surg. 2012;69(5):510-515. 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. 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). Major complications (1.6 %) included unilateral hematoma and localized infection. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). 1999;103(6):1682-1686. 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. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. 1997;185(6):593-603. Another set of breast pump supplies if you get pregnant . .arrowPurpleSmall, a:hover.arrowPurpleSmall { 2014b;48(5):334-339. Breast Concerns of Adolescents. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. The Mammotome procedure represented another novel therapeutic option for gynecomastia. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. } Kalliainen LK; ASPS Health Policy Committee. Sood R, Mount DL, Coleman JJ 3rd, et al. Level of Evidence = IV. And if you are in Canada the surgeon decides. border-width:0; Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. 2012;130(4):785-789. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. 2001;76(5):503-510. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. .newText { 2005;55(3):227-231. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Arch Dis Child. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. American Society of Plastic Surgeons (ASPS). However, these medications should be reserved for those with no decrease in breast size after 2 years. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Hoyos AE, Perez ME, Dominguez-Millan R, et al. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia. Breast Reduction | American Society of Plastic Surgeons 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. Reduction mammoplasty: Cosmetic or reconstructive procedure? The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. Prostate Cancer Prostatic Dis. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Treatment of adolescent gynecomastia. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Mayo Clin Proc. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). 1995;34(2):113-116. Scand J Plast Reconstr Hand Surg. Devalia HL, Layer GT. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. Gynecomastia: Evolving paradigm of management and comparison of techniques. list-style-type: decimal; 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). 2015;75(4):383-387. .fixedHeaderWrap { The Breast: Comprehensive Management of Benign and Malignant Diseases. Plast Reconstr Surg. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. 2000;44(2):125-134. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. 1993;17(3):211-223. Plast Reconstr Surg. 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). 2007;119(4):1159-1166. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Fagerlund A, Lewin R, Rufolo G, et al. Ann Plastic Surg. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. 2018;7(Suppl 1):S70-S76. 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). 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. 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: The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Plast Reconstr Surg. font-size: 18px; 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). 1998;41(3):240-245. 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. Risk of bias was assessed independently by 2review authors. 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. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. 2002;33:208-217. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . 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. PDF Clinical Policy Bulletin: BRCA Testing, Prophylactic Mastectomy - Aetna Computed tomography scan of adrenal glands to identify adrenal lesions. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. Plast Reconstr Surg. --> Copyright Aetna Inc. All rights reserved. OL LI { Statistical analysis was performed with student t-test and chi-square test. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. cursor: pointer; OL OL LI { OL OL OL LI { breast augmentation with implant. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. 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. skin should not be excised horizontally below the inframammary fold. J Am Coll Surg. position: fixed; Analysis was on an intention-to-treat basis. As explained below, 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. A total of 81 patients were included in this study. 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. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . 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). Breast J. 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. Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Anesthesia may be injected along with saline solution until the tissue is firm, and a suction cannula is used to extract fat from the breast. Plast Reconstr Surg. The risks included infection, wound breakdown, scarring, and the need for re-operating. Tang CL, Brown MH, Levine R, et al. 2013;71(5):471-475. Quality of life after breast reduction. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. OL OL OL OL OL LI { Collis N, McGuiness CM, Batchelor AG. 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. PDF Summary of Proposed Aetna Medicare Advantage Agreement Plast Reconstr Surg. 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. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. The study subjects were stratified into groups based on ages of <60 years and 60 years. Collins ED, Kerrigan CL, Kim M, et al. Current concepts in gynaecomastia. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Socioeconomic Committee Position Paper. 1999;103(6):1687-1690. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. color: blue!important; Policy Statement 6d: Aesthetic surgery procedures.