Stride Bank Chime Address, Articles A

Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. 2008;32(1):38-44. 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). ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). } 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. ASPS Recommended Coverage Criteria for Third Party Payors. } They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. J Plast Surg Hand Surg. Ann Plast Surg. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Socioeconomic Committee Position Paper. 1996;20(5):391-397. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Policy Statement 6d: Aesthetic surgery procedures. 2006;118(4):840-848. Fischer JP, Cleveland EC, Shang EK, et al. Surgery. Breast and aesthetic surgery. Asian J Surg. Plast Reconstr Surg. Mizgala CL, MacKenzie KM. Ann Plastic Surg. Administration of Benefits and Transition Responsibilities Devalia HL, Layer GT. .newText { Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Ann Plast Surg. 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). Reduction mammaplasty: The need for prospective randomized studies. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. A cohort study of breast cancer risk in breast reduction patients. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Tang CL, Brown MH, Levine R, et al. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Special Clinical Concerns. Washington, DC: ACOG; 2011:121-122. Am Surg. Long-term functional results after reduction mammoplasty. width: 100%; Plast Reconstr Surg. 2017;139(6):1313-1322. PLoS One. In addition, Nguyen et al (2004) ignored a wealth of published evidence of the effectiveness of physical therapy, analgesics and other conservative measures on back and neck pain generally. Chadbourne EB, Zhang S, Gordon MJ, et al. 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. Surgical implications of obesity. Bland KI, Copeland EM, eds. 2013;71(5):471-475. No necrosis, systemic infection, or muscle paralysis was reported. Ann Plastic Surg. Plastic surgery for teenagers briefing paper. Risk of bias was assessed independently by 2review authors. Surgical treatment is indicated when medical treatments fail. 01/04/2023 Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). (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. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. 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. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Reduction mammaplasty: Defining medical necessity. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. J Plast Surg Hand Surg. padding: 10px; Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Type II gynecomastia is more generalized breast enlargement. 1997;100(4):875-883. 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. 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. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. Level of Evidence = IV. Surgical management of gynecomastia--a 10-year analysis. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). 2006;30(3):309-319. For individuals who received radiation treatment to the chest . Variations in pattern of pubertal changes in girls. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Krieger LM, Lesavoy MA. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Cochrane Database Syst Rev. Fagerlund A, Cormio L, Palangi L, et al. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. 2001;108(1):62-67. 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. OL OL OL LI { American Society of Plastic and Reconstructive Surgery (ASPRS). Fischer S, Hirsch T, Hirche C, et al. 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). In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. Level of Evidence = IV. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. 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. Safran T, Abi-Rafeh J, Alabdulkarim A, 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. 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). Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Leclere FM, Spies M, Gohritz A, Vogt PM. The end-point was the complete resolution of gynecomastia. Arlington Heights, IL: ASPS; March 9, 2002. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 40 . 1993;17(3):211-223. Seitchik MW. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. } Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. All RCTs that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. OL OL OL OL LI { 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. padding: 15px; Little is known about the effect of surgical treatment on the psychological aspects of the disease. 2014a;34(1):66-73. Hello! Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Ages ranged from 18 to 66 years. } The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Recommended criteria for insurance coverage of reduction mammoplasty. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Glatt BS, Sarwer DB, O'Hara DE, et al. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne 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. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). 2012;130(4):785-789. Qu S, Zhang W, Li S, et al. 1999;103(6):1674-1681. Gonzalez FG, Walton RL, Shafer B, et al. color: #FFF; For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Plast Reconstr Surg. 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. /*margin-bottom: 43px;*/ Copyright Aetna Inc. All rights reserved. J Pediatr Surg. 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). Gynaecomastia. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. 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 primary outcome was the difference in wound drainage over 24 hours. 1998;41(3):240-245. First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. 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. There were 18 out of 415 studies eligible to review. Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. 2018;24(6):1043-1045. Breast Concerns of Adolescents. 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. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. color: blue!important; Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. 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. Reduction mammoplasty for macromastia. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. A total of 182 thirty-day postoperative surgical complications were documented, but stratifying patients into 2 age groups did not reveal an association between age and any surgical complication (P = .26). This may lead to additional scarring and additional operating time. Brown MH, Weinberg M, Chong N, et al. Burns JL, Blackwell SJ. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 2000;106(2):280-288. 2003;111(2):688-694. list-style-type: lower-roman; Gland Surg. 2000;44(2):125-134. Aesthet Plastic Surg. Breast J. 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. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 1. 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. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 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. 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). 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). Analysis was on an intention-to-treat basis. 2005;55(3):227-231. Follow-up ranged from 2 months to 3 years. 2015;49(6):363-366. 2021;74(11):3128-3140. 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. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life.