Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. 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. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. Collins ED, Kerrigan CL, Kim M, et al. OL OL LI { Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline background-color:#eee; 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. 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. 2006;30(3):309-319. A total of 15 articles met the inclusion criteria for review. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Another set of breast pump supplies if you get pregnant . 1994;21(3):539-543. Reduction mammaplasty: A review of managed care medical policy coverage criteria. 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. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? 1999;103(1):76-82; discussion 83-85. #backTop { Breast reduction surgery - Mayo Clinic 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. list-style-type: upper-alpha; The characteristics of patients as well as the curative effects between the 2 groups were analyzed. .newText { Karamanos E, Wei B, Siddiqui A, Rubinfeld I. A total of 90 patients underwent breast re-reduction surgery. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Often times, insurance company will dictate how much breast tissue to be removed. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. Chadbourne EB, Zhang S, Gordon MJ, et al. Collis N, McGuiness CM, Batchelor AG. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. Plast Reconstr Surg. 2014b;30(6):641-647. 2001;107(5):1234-1240. Risk factors for complications following breast reduction: Results from a randomized control trial. }. Reduction mammoplasty for macromastia. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Prepubertal gynecomastia linked to lavender and tea tree oils. Policy. In these cases, breast reduction for men may take 2 to 3 hours. Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Gland Surg. PDF Gender Dysphoria Treatment - Cigna A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. The authors reach the remarkable conclusion that a woman with normal sized breasts who has only a few ounces of breast tissue removed is as likely to receive as much benefit from breast reduction surgery as a women with large breasts who has substantially more breast tissue removed. The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. 2018;7(Suppl 1):S70-S76. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). 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). Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Endocrinol Metab Clin North Am. Can objective predictors for operative success be identified? 2016;20(3):256-260. In a systematic review, these investigators examined the role of radiotherapy in this context. Refer to the member's specific plan document for applicable coverage. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Reduction mammaplasty: Defining medical necessity. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. 1990;24(1):61-67. 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. 2014b;48(5):334-339. PDF Procedures, programs and drugs you must precertify - AmeriBen Administration of Benefits and Transition Responsibilities position: fixed; Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna 1995;95(1):77-83. Seitchik MW. Kerrigan CL, Collins ED, Kneeland TS, et al. 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. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. background-color: #cc0066; No new trials were identified for this first update. 2015;75(4):383-387. Ann Plastic Surg. 2nd ed. 2007;356(5):479-485. Breast Reduction Surgery and Gynecomastia Surgery - Medical - Aetna Policy Statement 6d: Aesthetic surgery procedures. Aesthetic Plast Surg. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. } Obstet Gynecol Clin North Am. There were 18 out of 415 studies eligible to review. 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. 1995;61(11):1001-1005. 1998;26(1):61-65. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. 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). Surgeon. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Resolution of idiopathic gynecomastia may take several months to years. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. #backTop:hover { J Am Coll Surg. No author listed. ol.numberedList LI { Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. border-width:0; The end-point was the complete resolution of gynecomastia. } A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. 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). 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. 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. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). 1998;41(3):240-245. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. 2001;76(5):503-510. 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. The mean age was 42.8 years (SD 19.5 years). 2020 Sep 4 [Online ahead of print]. Leclere FM, Spies M, Gohritz A, Vogt PM. 2000;44(2):125-134. No necrosis, systemic infection, or muscle paralysis was reported. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne 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. J Plast Surg Hand Surg. Ann Chir Plast Esthet. 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. Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. J Plast Reconstr Aesthet Surg. 2011;128(4):243e-249e. color: red!important; margin-bottom: 38px; 2006;118(4):840-848. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). 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: These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Surgical treatment is indicated when medical treatments fail. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. 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. 1995;34(2):113-116. 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. World J Surg. Plast Reconstr Surg. 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. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Plast Reconstr Surg. Plast Reconstr Surg. This Clinical Policy Bulletin may be updated and therefore is subject to change. 2008;121(4):1092-1100. 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: The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). 2002;33:208-217. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. /*margin-bottom: 43px;*/ 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. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Surgical management of gynecomastia--a 10-year analysis. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. 2018;89(6):408-412. 1998;49:215-234. Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. Because reduction mammoplasty may be used for both medically necessary and cosmetic indications, Aetna has set forth above objective criteria to distinguish medically necessary reduction mammoplasty from cosmetic reduction mammoplasty. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Breast reduction for symptomatic macromastia. American Society of Plastic Surgeons (ASPS). cursor: pointer; Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). 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. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Plast Reconstr Surg. 2008;32(1):38-44. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. With approval from the authors institutional ethics committee and written informed consent, a total of 22 patients with 33 abnormally hyperplastic breasts were enrolled at the First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. text-decoration: underline; It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. Subjects were compared to age-matched norms from another study cohort. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. 2015;49(6):311-318. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. 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. Scand J Plast Reconstr Hand Surg. 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.