Burdette TE, Kerrigan CL, Homa KA. 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. 2021;74(11):3128-3140. Refer to the member's specific plan document for applicable coverage. Lonie S, Sachs R, Shen A, et al. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. 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: For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Principles of breast re-reduction: A reappraisal. ol.numberedList LI { There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). Administration of Benefits and Transition Responsibilities World J Surg. No new trials were identified for this first update. Fagerlund A, Cormio L, Palangi L, et al. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. 2001;108(6):1591-1599. Gynecomastia in patients with prostate cancer: Update on treatment options. Arch Dis Child. Gonzalez FG, Walton RL, Shafer B, et al. 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. Ann Plast Surg. Araco A, Gravante G, Araco F, et al. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. 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. 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). These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. J Am Coll Surg. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Karamanos et al (2015) identified their study as the largest sample on breast reduction in the literature, in which age and surgeon specialty did not correlate with negative results. Treating providers are solely responsible for medical advice and treatment of members. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. 1969;44(235):291-303. The Mammotome procedure represented another novel therapeutic option for gynecomastia. Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. Narula HS, Carlson HE. 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. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. background-position: right 65%; 2014b;48(5):334-339. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. 1999;103(6):1674-1681. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Gynecomastia may be drug-induced. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. 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. A systematic search of the published literature was performed. Fischer JP, Cleveland EC, Shang EK, et al. Aesthetic Plast Surg. Bland KI, Copeland EM, eds. 2018;24(6):1043-1045. J Plast Surg Hand Surg. ASPS Recommended Coverage Criteria for Third Party Payors. However, these medications should be reserved for those with no decrease in breast size after 2 years. You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. To get insurance coverage, you'll probably need . Breast J. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? 2000;106(5):991-997. 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). Collins ED, Kerrigan CL, Kim M, et al. 2006;9(2):109-114. There were 18 out of 415 studies eligible to review. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Measuring health state preferences in women with breast hypertrophy. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Cochrane Database Syst Rev. Med Decis Making. 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). However, it is unclear if there is any evidence to support this practice. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. padding: 10px; Aesthet Plastic Surg. 2010;45(3):650-654. .headerBar { Gynecomastia has been classified into2 types. display: none; Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. Kalliainen LK; ASPS Health Policy Committee. Autorino R, Perdona S, D'Armiento M, et al. 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. Aesthet Surg J. 2000;45(6):575-580. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). A total of 15 articles met the inclusion criteria for review. text-decoration: underline; top: 0px; Macromastia: all . It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. background-color: #cc0066; Level of Evidence = IV. 1999;103(1):76-82; discussion 83-85. Ann Plast Surg. See Appendix for Table 1. Burns JL, Blackwell SJ. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. A physician-supervised diet and exercise plan may be indicated in obese patients. 2007;356(5):479-485. Plast Reconstr 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 . 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. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. 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. background-color: #663399; 2015;(10):CD007258. The mean volume of tissue resected was 250 g (range of 22 to 758 g) from the right breast and 244 g (range of 15 to 705 g) from the left breast. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Reduction mammoplasty for asymptomatic members is considered cosmetic. 1993;91(7):1270-1276. 1993;17(3):211-223. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 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]. 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. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Three review authors undertook independent screening of the search results. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. J Pediatr Surg. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. .fixedHeaderWrap { This investigators stated that these studies should include data from older individuals affected by gynecomastia and utilize valid tools of psychological measurement in order to better quantify the effect; elderly patients affected by the disease have been over-looked in the current research; more data on this subject could improve the pre-operative evaluation of these patients and help identify the patients who will benefit from treatment. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. 2017;35:157-161. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . --> Reduction mammoplasty: Cosmetic or reconstructive procedure? J Plast Surg Hand Surg. 2015;10(8):e0136094. Brown DM, Young VL. color:#eee; Plast Reconstr Surg. OL OL LI { Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Obesity and complications in breast reduction surgery: Are restrictions justified? Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. Aetna considers breast reconstructive surgery to correct 1. 2011;128(4):243e-249e. No data were provided on loss to follow-up. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Krieger LM, Lesavoy MA. Oxfordshire NHS Trust. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. 40 . Mayo Clin Proc. Level of Evidence = IV. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. Breast reduction for symptomatic macromastia. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001).