Ann Plast Surg. American Society of Plastic and Reconstructive Surgery (ASPRS). 2 . Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Arch Dis Child. 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. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. In these cases, breast reduction for men may take 2 to 3 hours. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. 1997;100(4):875-883. They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. Khan SM, Smeulders MJ, Van der Horst CM. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . 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). Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. 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). 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. Determinants of surgical site infection after breast surgery. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Collis N, McGuiness CM, Batchelor AG. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. 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. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Devalia HL, Layer GT. 2006;118(4):840-848. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Plast Reconstr Surg. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. The risks included infection, wound breakdown, scarring, and the need for re-operating. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. Plastic Reconstr Surg. Handschin AE, Bietry D, Hsler R, et al. Surgical treatment is indicated when medical treatments fail. Socioeconomic Committee Position Paper. All the patients recovered well and were satisfied with the cosmetic outcomes. 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). N Engl J Med. 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. Sugrue CM, McInerney N, Joyce CW, et al. Major complications (1.6 %) included unilateral hematoma and localized infection. There were no restrictions on the basis of date or language of publication. The author concluded that the current level of evidence on this subject was very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. Hoyos AE, Perez ME, Dominguez-Millan R, et al. 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. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Aesthetic Plast Surg. color:#eee; Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. J Plast Reconstr Aesthet Surg. Plast Reconstr Surg. position: fixed; Narula HS, Carlson HE. 2007;119(4):1159-1166. list-style-type: upper-roman; Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Plastic surgery for teenagers briefing paper. Hello! 2015;75(4):383-387. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Disproportionately large breasts can cause both physical and emotional . border-width:0; 1995;61(11):1001-1005. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. 2017;35:157-161. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. 2008;61(5):493-502. skin should not be excised horizontally below the inframammary fold. cursor: pointer; Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. This may lead to additional scarring and additional operating time. Plast Reconstr Surg. Three review authors undertook independent screening of the search results. 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. Principles of breast re-reduction: A reappraisal. Links to various non-Aetna sites are provided for your convenience only. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Many men with breast enlargement are found to have pseudo-gynecomastia. list-style-type : square !important; Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Am Surg. 2017;139(6):1313-1322. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. The authors concluded that the limited evidence available showed no significant benefit of using post-operative wound drains in reduction mammoplasty, although LOS may be shorter when drains are not used. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. 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. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. background-color:#eee; 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. color: red!important; 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. For many patients the psychological impact of the disease is substantial. Plast Reconstr Surg. American Society of Plastic Surgeons (ASPS). background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; 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). } text-decoration: line-through; Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. J Plast Surg Hand Surg. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. If an insufficient amount of breast tissue is removed, the surgery is less likely to be successful in relieving pain and any related symptoms from excessive breast weight (e.g., excoriations, rash). J Plast Reconstr Aesthet Surg. Special Clinical Concerns. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). z-index: 99; 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. Prostate Cancer Prostatic Dis. Aesthetic Plast Surg. 1. Townsend: Sabiston Textbook of Surgery. 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. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. Marshall WA, Tanner JM. 2006;9(2):109-114. 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. } The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. #backTop:hover { Kerrigan CL, Collins ED, Kneeland TS, et al. Level of Evidence = IV. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. OL OL LI { Wound drainage after plastic and reconstructive surgery of the breast. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. } Reduction mammoplasty: Cosmetic or reconstructive procedure? First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) 01/04/2023 2014b;48(5):334-339. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Mental health care professionals may be consulted to address psychological distress from gynecomastia. Plastic Reconstruct Surg. A systematic search of the published literature was performed. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. border: none; This will be computed based on your body area. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. 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. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Statistical analysis was performed with student t-test and chi-square test. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. 2018;89(6):408-412. 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). Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. color: #FFF; Scand J Plast Reconstr Hand Surg. J Laparoendosc Adv Surg Tech A. margin-top: 38px; American Society of Plastic Surgeons (ASPS). They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. The end-point was the complete resolution of gynecomastia. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. 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.