Devalia HL, Layer GT. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. Another set of breast pump supplies if you get pregnant . Guidelines for Adolescent Health Care. Subjects were compared to age-matched norms from another study cohort. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Plast Reconstr Surg. 2008;53(3):255-261. PLoS One. color: red!important; 2019;166(5):934-939. (25 y/o female with a 38J bra size) according to aetna, I should more than qualify for a reduction as I have back, neck, shoulder pain, chest pain and pressure, arm numbness while laying on sides, etc. 2012;130(4):785-789. J Am Coll Surg. Recommended criteria for insurance coverage of reduction mammoplasty. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. A total of 15 articles met the inclusion criteria for review. 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. Leclere FM, Spies M, Gohritz A, Vogt PM. Ann Plast Surg. 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 . border-width:0; The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. Grooving where the bra straps sit on the shoulder. 2006;118(4):840-848. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Gland Surg. 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. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. Tang CL, Brown MH, Levine R, et al. ul.ur li{ Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Analysis was on an intention-to-treat basis. Gynecomastia in patients with prostate cancer: A systematic review. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Women's Health and Cancer Rights Act of 1998. 2005;55(3):227-231. Last Review01/04/2023. } color: white; 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). Also, there was no correlation between PR expression and 2D: 4D. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Plast Reconstr Surg. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. 1. Fagerlund A, Lewin R, Rufolo G, et al. Surgical treatment of primary gynecomastia in children and adolescents. 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). outline: none; Reduction mammaplasty. J Plast Reconstr Aesthet Surg. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. 1998;101(2):361-364. Reduction mammoplasty for asymptomatic members is considered cosmetic. Horm Res Paediatr. padding-bottom: 4px; Gynecomastia. Handschin AE, Bietry D, Hsler R, et al. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. An 18-question survey was created evaluating various aspects of BBR practice; UK and Irish plastic and reconstructive and breast surgeons were invited to participate by an e-mail containing a link to a web-based survey. The authors concluded that breast re-reduction can be performed safely and predictably, even when the previous technique is not known; and 4 key principles were developed: Language services can be provided by calling the number on your member ID card. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. 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. 2006;30(3):309-319. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. 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 surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. /* aetna.com standards styles for templates */ From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. 2015;49(6):363-366. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. In the case of reduction mammoplasty for relief of back, neck and shoulder pain, Aetna has considered this procedure medically necessary in women with excessively large breasts because it seems logical, even in the absence of firm clinical trial evidence, that this excessive weight would contribute to back and shoulder pain, and that removal of this excessive breast tissue would provide substantial pain relief, reductions in disability, and improvements in function. Breast reduction for symptomatic macromastia. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. .newText { Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. 2000;106(5):991-997. Ann Plast Surg. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. 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). While 1 study showed high patient's satisfaction rate; both studies indicated high surgeon's satisfaction rate. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Treating providers are solely responsible for medical advice and treatment of members. Surg Laparosc Endosc Percutan Tech. Gynecomastia may be drug-induced. 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. Washington, DC: ACOG; 2011:121-122. 1995;95(1):77-83. Level of Evidence = III. Breast and aesthetic surgery. 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). Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. Breast Concerns of Adolescents. Surgical treatment is indicated when medical treatments fail. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. There were only 2 studies of a total 25 patients that were considered as good in quality. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. 1991;27(3):232-237. Ages ranged from 18 to 66 years. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes.