Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). } Special Clinical Concerns. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Surgical management of gynecomastia--a 10-year analysis. Resolution of idiopathic gynecomastia may take several months to years. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. 1998;101(2):361-364. 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: 2014b;48(5):334-339. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; skin should not be excised horizontally below the inframammary fold. Reduction mammoplasty for macromastia. 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. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. } list-style-type: upper-alpha; Arlington Heights, IL: ASPS; March 9, 2002. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. 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. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. 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. Sugrue CM, McInerney N, Joyce CW, et al. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). OL OL OL OL OL LI { Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Other just require 500 grams no matter what your height and weight. 1999;103(6):1687-1690. Type II gynecomastia is more generalized breast enlargement. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. Plast Reconstr Surg. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. 2008;121(4):1092-1100. Arlington Heights, IL: ASPRS; 1987. Scand J Plast Reconstr Hand Surg. background: #5e9732; background-color: #663399; The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. 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. The average age was 24.7 years (range of 18 to 47 years). No new trials were identified for this first update. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. This Clinical Policy Bulletin may be updated and therefore is subject to change. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). Reduction mammaplasty: Defining medical necessity. Treating providers are solely responsible for medical advice and treatment of members. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Ann Plast Surg. 18th ed. Plast Reconstr Surg. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Kasielska-Trojan A, Danilewicz M, Antoszewski B. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. 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 As explained below, 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. Reduction mammoplasty improves symptoms of macromastia. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. The majority (87.7 %) of cases presented with accompanying mastalgia. }. /* aetna.com standards styles for templates */ PLoS One. 2008;53(3):255-261. background-position: right 65%; These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. 2002;109(5):1556-1566. 2015;49(6):363-366. Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. Gynecomastia in patients with prostate cancer: Update on treatment options. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Variations in pattern of pubertal changes in girls. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. 2021;147(5):1072-1083. A detailed physical examination, including testicular examination. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. } Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. ASPS clinical practice guideline summary on reduction mammaplasty. Little is known about the effect of surgical treatment on the psychological aspects of the disease. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. color:#eee; The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. 2001;76(5):503-510. display: block; Aesthetic Plast Surg. border-width:0; Fagerlund A, Cormio L, Palangi L, et al. Breast. The following procedures are considered experimental and investigational because there is insufficient evidence of itseffectiveness or itseffectiveness has not been established: Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. Principles of breast re-reduction: A reappraisal. Gynecomastia is a very common concern of male adolescence. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 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. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. 2006;9(2):109-114. However, these medications should be reserved for those with no decrease in breast size after 2 years. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Washington, DC: ACOG; 2011:121-122. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. Arlington Heights, IL: ASPS; May 2011. Ann Plast Surg. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. 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. Breast J. Breast reduction for symptomatic macromastia. cursor: pointer;