From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. 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). Surgery. Ann Plast Surg. 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. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). top: 0px; The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. 1994;21(3):539-543. 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. Khan SM, Smeulders MJ, Van der Horst CM. J Plast Surg Hand Surg. A cohort study of breast cancer risk in breast reduction patients. Collis N, McGuiness CM, Batchelor AG. 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. Reduction mammoplasty improves symptoms of macromastia. Breast asymmetries: A brief review and our experience. Fischer JP, Cleveland EC, Shang EK, et al. Refer to the member's specific plan document for applicable coverage. 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]). 01/04/2023 Gland Surg. 2007;36(2):497-519. Arlington Heights, IL: ASPS; 2011. Surgical treatment of gynecomastia: Complications and outcomes. A total of 244 out of 1,628 patients with the average age of 23.13 years. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. The majority (87.7 %) of cases presented with accompanying mastalgia. 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. 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). Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. skin should not be excised horizontally below the inframammary fold. Note: Chronic intertrigo, eczema, dermatitis, and/or ulceration in the infra-mammary fold in and of themselves are not considered medically necessary indications for reduction mammoplasty. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. World J Surg. Type II gynecomastia is more generalized breast enlargement. A total of 15 articles met the inclusion criteria for review. There were only 2 studies of a total 25 patients that were considered as good in quality. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. 2000;106(2):280-288. Plast Reconstr Surg. Surgical management of gynecomastia--a 10-year analysis. The end-point was the complete resolution of gynecomastia. Risk factors for complications following breast reduction: Results from a randomized control trial. 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. breast augmentation with implant. Raispis T, Zehring RD, Downey DL. 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. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. cursor: pointer; You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Med Decis Making. OL OL LI { Plast Reconstr Surg. Plast Reconstr Surg. This may lead to additional scarring and additional operating time. --> 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.. In these cases, breast reduction for men may take 2 to 3 hours. 1997;185(6):593-603. Priorities Forum Policy Statement. Disproportionately large breasts can cause both physical and emotional . Special Clinical Concerns. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Gynaecomastia. Oxford, UK: National Health Service (NHS); October 2008. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the A total of 182 thirty-day postoperative surgical complications were documented, but stratifying patients into 2 age groups did not reveal an association between age and any surgical complication (P = .26). Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. For medical Reduction mammoplasty: Criteria for insurance coverage. Gynecomastia: Evolving paradigm of management and comparison of techniques. Treating providers are solely responsible for medical advice and treatment of members. Ann Plast Surg. ol.numberedList LI { 2021;74(11):3128-3140. Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . American Society of Plastic and Reconstructive Surgery (ASPRS). Computed tomography scan of adrenal glands to identify adrenal lesions. } .newText { If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. } Plast Reconstr Surg. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. 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. 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. Schnur et al (1991) reported on a sliding scale assigns a weight of breast tissue to be removed based on body weight and surface area. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. 2015;75(4):383-387. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. However, these medications should be reserved for those with no decrease in breast size after 2 years. 2019;166(5):934-939. 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). For many patients the psychological impact of the disease is substantial. list-style-type: decimal; border: none; 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. Pain/discomfort/ulceration from bra straps cutting into shoulders; Skin breakdown (severe soft tissue infection, tissue necrosis, ulceration hemorrhage) from overlying breast tissue; There is a reasonable likelihood that the member's symptoms are primarily due to macromastia; Reduction mammoplasty (also spelled as 'mammaplasty') is likely to result in improvement of the chronic pain; Pain symptoms persist as documented by the physician despite at least a 3-month trial of therapeutic measures such as: Analgesic/non-steroidal anti-inflammatory drugs (NSAIDs) interventions and/or muscle relaxants, Dermatologic therapy of ulcers, necrosis and refractory infection, Physical therapy/exercises/posturing maneuvers, Supportive devices (e.g., proper bra support, wide bra straps), Chiropractic care or osteopathic manipulative treatment. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. Aesthet Surg J. In the case of reduction mammoplasty for relief of back, neck and shoulder pain, Aetna has considered this procedure medically necessary in women with excessively large breasts because it seems logical, even in the absence of firm clinical trial evidence, that this excessive weight would contribute to back and shoulder pain, and that removal of this excessive breast tissue would provide substantial pain relief, reductions in disability, and improvements in function. While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. Tang CL, Brown MH, Levine R, et al. Chadbourne EB, Zhang S, Gordon MJ, et al. Can objective predictors for operative success be identified? Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Handschin AE, Bietry D, Hsler R, et al. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Ann Plastic Surg. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Many men with breast enlargement are found to have pseudo-gynecomastia. background: #5e9732; The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. and areola. Fagerlund A, Lewin R, Rufolo G, et al. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. A total of 90 patients underwent breast re-reduction surgery. list-style-type : square !important; Surgeon. Aesthet Surg J. 40 . The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 2018;89(6):408-412. The mean age was 42.8 years (SD 19.5 years). 2008;32(1):38-44. color:#eee; 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). It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. 1999;103(6):1687-1690. J Plast Reconstr Aesthet Surg. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. 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. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. 1969;44(235):291-303. list-style-type: lower-alpha; /* aetna.com standards styles for templates */ No author listed. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Macromastia: all . 2 . Reduction mammaplasty. Statistical analysis was performed with student t-test and chi-square test. Gynecomastia in patients with prostate cancer: Update on treatment options. 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). Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. This Clinical Policy Bulletin may be updated and therefore is subject to change. 2009;7(2):114-119. Glatt BS, Sarwer DB, O'Hara DE, et al. 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. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Resolution of idiopathic gynecomastia may take several months to years. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). 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). 1999;103(6):1682-1686. 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. Endocrinol Metab Clin North Am. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). 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. 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. 2015;(10):CD007258. Brown MH, Weinberg M, Chong N, et al. } Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. 2001;107(5):1234-1240. Devalia HL, Layer GT. 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. } Aetna considers breast reconstructive surgery to correct Coding 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. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Recommended criteria for insurance coverage of reduction mammoplasty. In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Plast Reconstr Surg. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Gynecomastia is a very common concern of male adolescence. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. } 2002;33:208-217. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. } Gynecomastia. There were 18 out of 415 studies eligible to review. Mayo Clin Proc. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. ul.ur li{ border-width:0; Obstet Gynecol Clin North Am.