2019;8(4):431-440. In these cases, breast reduction for men may take 2 to 3 hours. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Ann Plast Surg. No new trials were identified for this first update. 2000;106(2):280-288. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Policy Statement 6d: Aesthetic surgery procedures. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. 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. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). In a review on Surgical treatment of primary gynecomastia in children and adolescents, Fischer et al (2014b) concluded that surgical correction of gynecomastia remains a purely elective intervention. background-color: #663399; 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. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Level of Evidence = IV. Burns JL, Blackwell SJ. Plastic Reconstr Surg. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. The risks included infection, wound breakdown, scarring, and the need for re-operating. 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. Plast Reconstr Surg. For many patients the psychological impact of the disease is substantial. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. 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. color: red 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). From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. Socioeconomic Committee Position Paper. 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. The majority (87.7 %) of cases presented with accompanying mastalgia. 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. 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. He Q, Zheng L, Zhuang D, et al. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. 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. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. 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. The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). Breast and aesthetic surgery. Level of Evidence = IV. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Plast Reconstr Surg. 2006;9(2):109-114. 1999;103(1):76-82; discussion 83-85. You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. list-style-type: lower-roman; Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. J Pediatr Surg. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Chadbourne EB, Zhang S, Gordon MJ, et al. Plast Reconstr Surg. 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. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Kalliainen LK; ASPS Health Policy Committee. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Collins ED, Kerrigan CL, Kim M, et al. Gland Surg. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. 18th ed. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass 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. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Aesthetic Plast Surg. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. list-style-type: lower-alpha; The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Aetna considers breast reconstructive surgery to correct 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. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. }. 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. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. list-style-type: decimal; Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. 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. } 2010;125(5):1301-1308. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Schnur PL, Hoehn JG, Ilstrup DM, et al. Surgical management of gynecomastia--a 10-year analysis. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Devalia HL, Layer GT. cursor: pointer; A total of 244 out of 1,628 patients with the average age of 23.13 years. Ann Plast Surg. Little is known about the effect of surgical treatment on the psychological aspects of the disease. 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). ASPS clinical practice guideline summary on reduction mammaplasty. Management of gestational gigantomastia. (25 y/o female with a 38J bra size) according to aetna, I should more than qualify for a reduction as I have back, neck, shoulder pain, chest pain and pressure, arm numbness while laying on sides, etc. Recommended criteria for insurance coverage of reduction mammoplasty. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). Cochrane Database Syst Rev. 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. padding: 15px; 2020 Sep 4 [Online ahead of print]. 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. 2009;62(2):195-199. background-color:#eee; 2001;107(5):1234-1240. Med Decis Making. background-position: right 65%; Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Plastic Reconstruct Surg. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Kerrigan CL, Collins ED, Kim HM, et al. Plast Reconstr Surg. .strikeThrough { Grooving where the bra straps sit on the shoulder. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. 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. Araco A, Gravante G, Araco F, et al. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . 1994;21(3):539-543. Computed tomography scan of adrenal glands to identify adrenal lesions. Guidelines for Adolescent Health Care. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. 1995;95(1):77-83. The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 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. Ann Plastic Surg. Mistry RM, MacLennan SE, Hall-Findlay EJ. 2008;121(4):1092-1100. Arlington Heights, IL: ASPS; March 9, 2002. 2014a;34(1):66-73. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. There were no restrictions on the basis of date or language of publication. 2001;108(6):1591-1599. There were only 2 studies of a total 25 patients that were considered as good in quality. Women's Health and Cancer Rights Act of 1998. 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. of the following criteria must be met: Treatment of adolescent gynecomastia. Ann Plast Surg. OL OL LI { Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. 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. height:2px; Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. 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 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. Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. Reduction mammoplasty for macromastia. Surg Laparosc Endosc Percutan Tech. N Engl J Med. Level of Evidence = IV. 2002;109(5):1556-1566. 1999;103(6):1674-1681. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. 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.. Blomqvist L, Eriksson A, Brandberg Y. 1. Well-designed trials are especially important in assessing pain management interventions to isolate the contribution of the intervention from placebo effects, the effects of other concurrently administered pain management interventions, and the natural history of the medical condition.