display: block; He Q, Zheng L, Zhuang D, et al. 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. 1993;91(7):1270-1276. } OL OL OL OL LI { Cochrane Database Syst Rev. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Disproportionately large breasts can cause both physical and emotional . Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Gonzalez FG, Walton RL, Shafer B, et al. 1995;61(11):1001-1005. 2014;20(3):274-278. 2004;113(1):436-437. The mean age was 42.8 years (SD 19.5 years). 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]. --> Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. } Petty PM, Solomon M, Buchel EW, Tran NV. 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). 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). 2014b;30(6):641-647. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. of . The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. 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. 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. padding-right: 18px; Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Chadbourne EB, Zhang S, Gordon MJ, et al. 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. 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%. 2014a;34(3):409-416. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. 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. When seeking preauthorization for a breast reduction, your goal is generally twofold. 1994;21(3):539-543. The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). .arrowPurpleSmall, a:hover.arrowPurpleSmall { Reduction mammoplasty improves symptoms of macromastia. 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. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Reduction mammaplasty: Defining medical necessity. } Plast Reconstr Surg. Plast Reconstr Surg. 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). Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. li.bullet { Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. American Society of Plastic Surgeons (ASPS). Ann Plast Surg. J Plast Reconstr Aesthet Surg. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. This Clinical Policy Bulletin may be updated and therefore is subject to change. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. 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. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. @media print { Hello! Surgical treatment of gynecomastia by vacuum-assisted biopsy device. 2001;108(6):1591-1599. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. cursor: pointer; Level of Evidence = IV. Wound drainage after plastic and reconstructive surgery of the breast. Emiroglu M, Salimoglu S, Karaali C, et al. 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: In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. 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). 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. 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. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 01/04/2023 Ann Chir Plast Esthet. 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. Obstet Gynecol Clin North Am. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. No statistically significant differences in the drainage, level of pain, size of open areas, clinical appearance, degree of scar pliability, or scar erythema were noted. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. In: Townsend CM, Beuchamp RD, Evers BM, eds. Breast J. Risk factors for complications following breast reduction: Results from a randomized control trial. Lonie S, Sachs R, Shen A, et al. Can objective predictors for operative success be identified? Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. Reduction mammoplasty: Criteria for insurance coverage. 2015;75(4):383-387. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. hr.separator { Tang CL, Brown MH, Levine R, et al. 1990;24(1):61-67. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Also, there was no correlation between PR expression and 2D: 4D. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Gynaecomastia. } Breast cancer found at the time of breast reduction. /*margin-bottom: 43px;*/ 40 . Devalia HL, Layer GT. Narula HS, Carlson HE. ol.numberedList LI { Ann Plast Surg. 2008;32(1):38-44. Fagerlund A, Lewin R, Rufolo G, et al. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Breast Concerns of Adolescents. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. 1998;49:215-234. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Refer to the member's specific plan document for applicable coverage. Aesthet Surg J. Autorino R, Perdona S, D'Armiento M, et al. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Seitchik MW. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. 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. 2000;45(6):575-580. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. Subjects were compared to age-matched norms from another study cohort. 2003;111(2):688-694. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Horm Res Paediatr. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life.
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