40 . Plast Reconstr Surg. 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. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Schnur PL, Hoehn JG, Ilstrup DM, et al. 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. 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). Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Leclere FM, Spies M, Gohritz A, Vogt PM. 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. 1999;103(6):1682-1686. Reduction mammoplasty improves symptoms of macromastia. Please check your insurance policy to see whether breast reduction is a covered procedure. 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). All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). 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. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Breast reduction outcome study. Emiroglu M, Salimoglu S, Karaali C, et al. Plastic Reconstruct Surg. color: red!important; .strikeThrough { list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. GP Notebook. Plast Reconstr Surg. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Two review authors undertook independent data extraction of study characteristics, methodological quality and outcomes (e.g., infection, other wound complications, pain, and length of hospital stay [LOS]). 18th ed. Reduction mammaplasty. Coding 01/04/2023 Am J Infect Control. } Gynecomastia in patients with prostate cancer: A systematic review. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Gynecomastia has been classified into2 types. 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. Type II gynecomastia is more generalized breast enlargement. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. OL OL OL LI { Bland KI, Copeland EM, eds. 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. background-color: #663399; A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. Nelson et al (2014b) separately conducted a population level analysis of the 2005-2011 NSQIP datasets, identifying patient who underwent reduction mammoplasty, to determine the impact of obesity on early complications after reduction mammoplasty. 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%. OL OL OL OL LI { 1993;91(7):1270-1276. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 2000;106(5):991-997. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Autorino R, Perdona S, D'Armiento M, et al. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Ann Plast Surg. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Principles of breast re-reduction: A reappraisal. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. 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. Townsend: Sabiston Textbook of Surgery. There were only 2 studies of a total 25 patients that were considered as good in quality. 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. Chadbourne EB, Zhang S, Gordon MJ, et al. ASPS clinical practice guideline summary on reduction mammaplasty. list-style-type: upper-alpha; 2006;118(4):840-848. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. 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. J Laparoendosc Adv Surg Tech A. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. 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. Women's Health and Cancer Rights Act of 1998. Aesthetic Plast Surg. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. 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. Aesthet Plastic Surg. This may lead to additional scarring and additional operating time. Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. Flancbaum L, Choban PS. Surgical treatment of gynecomastia: Complications and outcomes. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review 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. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Management of gestational gigantomastia. Plast Reconstr Surg. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. 1999;103(1):76-82; discussion 83-85. Breast hypertrophy. Breast J. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Surgical implications of obesity. 2009;7(2):114-119. Obesity and complications in breast reduction surgery: Are restrictions justified? Oxfordshire NHS Trust. Measuring health state preferences in women with breast hypertrophy. Mistry RM, MacLennan SE, Hall-Findlay EJ. 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. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Surg Laparosc Endosc Percutan Tech. 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: Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. J Plast Surg Hand Surg. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. 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. of the following criteria must be met: 2000;106(2):280-288. 2006;9(2):109-114. .headerBar { The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. list-style-type: decimal; 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. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Breast J. Reduction mammaplasty: An outcome study. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. list-style-type : square !important; 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. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Gonzalez FG, Walton RL, Shafer B, et al. Oxford, UK: National Health Service (NHS); October 2008. Reduction mammaplasty provides long-term improvement in health status and quality of life. 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. Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. 2021;74(11):3128-3140. } 2007;36(2):497-519. 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). 2021;147(5):1072-1083. Treating providers are solely responsible for medical advice and treatment of members. Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects.

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