Aesthet Surg J. 1993;17(3):211-223. 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. Measuring health state preferences in women with breast hypertrophy. 2015;75(4):383-387. The primary outcome was the difference in wound drainage over 24 hours. 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. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Ann Plast Surg. padding: 10px; Resolution of idiopathic gynecomastia may take several months to years. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. OL LI { 1990;24(1):61-67. color: #FFF; Plast Reconstr Surg. Surgical treatment of primary gynecomastia in children and adolescents. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). Flancbaum L, Choban PS. Aetna plans exclude coverage of cosmetic surgery that is not medically necessary, . These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. margin-top: 38px; 2008;121(4):1092-1100. 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. list-style-type: lower-alpha; Asian J Surg. Am J Infect Control. list-style-type : square !important; Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. 2005;58(3):286-289. padding-right: 18px; The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Breast reduction for symptomatic macromastia. Abnormalities in Adolescent Breast Development. 18th ed. Collins ED, Kerrigan CL, Kim M, et al. Breast hypertrophy. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. list-style-type: upper-alpha; the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Surgical treatment is indicated when medical treatments fail. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Ann Plast Surg. 2009;19(3):e85-e90. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Plast Reconstr Surg. The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. Computed tomography scan of adrenal glands to identify adrenal lesions. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) 2001;108(6):1591-1599. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. 1995;61(11):1001-1005. Plastic Reconstr Surg. 2002;109(5):1556-1566. Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for 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. Little is known about the effect of surgical treatment on the psychological aspects of the disease. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). Surgical treatment of gynecomastia: Complications and outcomes. Surgical implications of obesity. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Ann Plast Surg. 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]. Management of gestational gigantomastia. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Evidence-based clinical practice guideline: Reduction mammaplasty. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). 2019;166(5):934-939. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. cursor: pointer; Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Principles of breast re-reduction: A reappraisal. Yao Y, Yang Y, Liu J, et al. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. } Obstet Gynecol Clin North Am. 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. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. 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. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. In these cases, breast reduction for men may take 2 to 3 hours. 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). Treating providers are solely responsible for medical advice and treatment of members. Horm Res Paediatr. 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? Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. Aesthetic Plast Surg. A non-standardized survey showed a very high satisfaction index. Major complications (1.6 %) included unilateral hematoma and localized infection. American Society of Plastic Surgeons (ASPS). 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). Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . The condition not only must be unresponsive to dermatological treatments (e.g., antibiotics or antifungal therapy) and conservative measures (e.g., good skin hygiene, adequate nutrition) for a period of 6 months or longer, but also must satisfy criteria stated insection I above. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammoplasty. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. Gynecomastia: Evolving paradigm of management and comparison of techniques. Subjects were compared to age-matched norms from another study cohort. Surgical management of gynecomastia--a 10-year analysis. In a systematic review, these investigators examined the role of radiotherapy in this context.
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