Fischer S, Hirsch T, Hirche C, et al. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Breast hypertrophy. .strikeThrough { Collis N, McGuiness CM, Batchelor AG. No other operation-related complications were observed. Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). 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. Kerrigan CL, Collins ED, Kim HM, et al. In this study the National Surgical Quality Improvement Program data set was queried for the Current Procedural Terminology code 19318 from the years 2005 to 2010, with principal outcome measurements of wound complications, surgical site infections, and reoperations. } They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. For medical 1997;185(6):593-603. Oxford, UK: National Health Service (NHS); October 2008. Analysis was on an intention-to-treat basis. list-style-type: upper-alpha; There were only 2 studies of a total 25 patients that were considered as good in quality. Surg Laparosc Endosc Percutan Tech. 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). li.bullet { Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. background-color: #cc0066; OL LI { } Ages ranged from 18 to 66 years. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Breast and aesthetic surgery. 18th ed. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Nguyen JT, Wheatley MJ, Schnur PL, et al. Petty PM, Solomon M, Buchel EW, Tran NV. 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. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Ann Plastic Surg. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. 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. Flancbaum L, Choban PS. #backTop:hover { And if you are in Canada the surgeon decides. 2003;111(2):688-694. 2006;118(4):840-848. 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. The member has gigantomastia of pregnancy accompanied byany of the following complications, and delivery is not imminent: For medical necessity criteria for surgery to correct breast asymmetry, seeCPB 0185 - Breast Reconstructive Surgery. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. 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. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. } 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). Kasielska-Trojan A, Danilewicz M, Antoszewski B. In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. ol.numberedList LI { Risk of bias was assessed independently by 2review authors. display: block; Mistry RM, MacLennan SE, Hall-Findlay EJ. Disproportionately large breasts can cause both physical and emotional . Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Guidelines for Adolescent Health Care. cursor: pointer; Reduction mammoplasty: Cosmetic or reconstructive procedure? Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. --> This will be computed based on your body area. Gonzalez FG, Walton RL, Shafer B, et al. 1993;17(3):211-223. Plastic Reconstruct Surg. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. 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]. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 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: Ann Chir Plast Esthet. A total of 15 articles met the inclusion criteria for review. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Reduction mammaplasty: An outcome study. .headerBar { 2019;8(4):431-440. /* aetna.com standards styles for templates */ Exposure to partners using estrogen containing vaginal creams; Cancer chemotherapy (alkylating agents, methotrexate, vinca alkaloids, imatinib, combination chemotherapy), Androgen receptor blockers - bicalutamide, 5 reductase inhibitors - finasteride, dutasteride, Angiotensin converting enzyme inhibitors (captopril, enalapril), Calcium channelblockers(diltiazem, nifedipine, verapamil), Anabolic steroids(e.g., in body builders). The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. } PLoS One. } Bland KI, Copeland EM, eds. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Surgeon. width: 100%; Subjects were compared to age-matched norms from another study cohort. Devalia HL, Layer GT. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. 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., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. 1995;34(2):113-116. However, it is unclear if there is any evidence to support this practice. Plast Reconstr Surg. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. of the following criteria must be met: The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Saunders Co.; 1991. Ann Plastic Surg. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. To get insurance coverage, you'll probably need . N Engl J Med. 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). A total of 244 out of 1,628 patients with the average age of 23.13 years. list-style-type: decimal; text-decoration: line-through; 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. The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. Fagerlund A, Cormio L, Palangi L, et al. 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.
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