outline: none; Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Follow-up ranged from 2 months to 3 years. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). 1997;185(6):593-603. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Reduction mammaplasty provides long-term improvement in health status and quality of life. 2014a;34(3):409-416. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. 2017;35:157-161. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. } An average of 320 specimens were excised from each side with mean blood loss of 34 ml. American Society of Plastic Surgeons (ASPS). Determinants of surgical site infection after breast surgery. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Breast J. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Breast J. Obstet Gynecol Clin North Am. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. Three review authors undertook independent screening of the search results. Aesthetic Plast Surg. Handschin AE, Bietry D, Hsler R, et al. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. Plast Reconstr Surg. } J Plast Surg Hand Surg. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). 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). 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. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . This may lead to additional scarring and additional operating time. Statistical analysis was performed with student t-test and chi-square test. A follow-up study of 105 women with breast cancer following reduction mammaplasty. 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. Annu Rev Med. Breast cancer found at the time of breast reduction. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). Gynecomastia in patients with prostate cancer: Update on treatment options. Brown MH, Weinberg M, Chong N, et al. Sabistons Textbook of Surgery (Burns & Blackwell, 2008)states that breast size should be stable for one year: There is no set lower age limit but, for the adolescent with breast hypertrophy, reduction is deferred until the breasts have stopped growing and are stable in size for at least 12 months before surgery.. Policy Statement 6d: Aesthetic surgery procedures. Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. 2 . Mizgala CL, MacKenzie KM. Endocrinol Metab Clin North Am. World J Surg. Prostate Cancer Prostatic Dis. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Emiroglu M, Salimoglu S, Karaali C, et al. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Yao Y, Yang Y, Liu J, et al. Glatt BS, Sarwer DB, O'Hara DE, et al. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. 2015;(10):CD007258. 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. 2015;10(8):e0136094. z-index: 99; Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. 1999;103(6):1682-1686. J Plast Reconstr Aesthet Surg. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. 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. Hello! Kerrigan CL, Collins ED, Kneeland TS, et al. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. With approval from the authors institutional ethics committee and written informed consent, a total of 22 patients with 33 abnormally hyperplastic breasts were enrolled at the First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. Obesity and complications in breast reduction surgery: Are restrictions justified? list-style-type: decimal; Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. .headerBar { The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. Level of Evidence = III. text-decoration: line-through; The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Refer to the member's specific plan document for applicable coverage. 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. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Gynecomastia: A systematic review. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Gonzalez FG, Walton RL, Shafer B, et al. American Society of Plastic Surgeons (ASPS). Variations in pattern of pubertal changes in girls. Plast Reconstr Surg. Risk of bias was assessed independently by 2review authors. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Breast asymmetries: A brief review and our experience. .fixedHeaderWrap { Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . A physician-supervised diet and exercise plan may be indicated in obese patients. Gland Surg. The majority (87.7 %) of cases presented with accompanying mastalgia. 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. 2008;53(3):255-261. Marshall WA, Tanner JM. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 2020 Sep 4 [Online ahead of print]. 2010;45(3):650-654. 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. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. # font-weight: bold; These investigators searched the literature on the treatment of Simon's grade I and II gynecomastia in PubMed, Scopus, Science Direct, and Cochrane using keywords "gynecomastia" and "liposuction". Fagerlund A, Cormio L, Palangi L, et al. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Gynaecomastia. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. 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. list-style-type: lower-roman; Measuring health state preferences in women with breast hypertrophy. 2017;139(6):1313-1322. Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. 2008;61(5):493-502. Principles of breast re-reduction: A reappraisal. Kerrigan CL, Collins ED, Striplin D, et al. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. (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. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. Breast and aesthetic surgery. 1995;61(11):1001-1005. Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . } A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Ages ranged from 18 to 66 years. Reduction mammoplasty for macromastia. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. OL OL OL LI { Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Oxfordshire NHS Trust. The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. list-style-type: lower-alpha; Ann Plast Surg. Ann Chir Plast Esthet. All patients underwent routine investigations to exclude secondary causes of gynecomastia. 2015;75(4):383-387. } The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Grooving where the bra straps sit on the shoulder. Flancbaum L, Choban PS. Plast Reconstr Surg. When seeking preauthorization for a breast reduction, your goal is generally twofold. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Plast Reconstr Surg. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. J Pediatr Surg. A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio).