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Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Aesthet Plastic Surg. 2002;33:208-217. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. Furthermore, the lack of an expected "dose-response" relationship between the amount of breast tissue removed and the magnitude of symptomatic relief in these studies raises questions about the validity of these studies and the effectiveness of breast reduction as a method of relieving shoulder and back pain. No data were provided on loss to follow-up. 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. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. 2nd ed. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Fischer S, Hirsch T, Hirche C, et al. 2014a;34(3):409-416. 2009;62(2):195-199. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Miller AP, Zacher JB, Berggren RB, et al. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Gynecomastia has been classified into2 types. #backTop { 2019;166(5):934-939. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Reduction mammoplasty improves symptoms of macromastia. The risks included infection, wound breakdown, scarring, and the need for re-operating. PLoS One. Setala L, Papp A, Joukainen S, et al. 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. Yao Y, Yang Y, Liu J, et al. American Society of Plastic Surgeons (ASPS). Plastic Reconstruct Surg. 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. Magnetic Resonance Imaging (MRI) of the Breast - Aetna In these cases, breast reduction for men may take 2 to 3 hours. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. Breast. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. 2016;20(3):256-260. Flancbaum L, Choban PS. Lonie S, Sachs R, Shen A, et al. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. 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: background-color:#eee; Aesthetic Plast Surg. PDF 0185 Breast Reconstructive Surgery (1) - Aetna The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. li.bullet { color:#eee; Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. J Plast Reconstr Aesthet Surg. Rising Rates of Insurance Denial for Breast Reduction Surgery This conclusion is based primarily upon the Breast Reduction Assessment of Value and Outcomes (BRAVO) study, which is described in several articles (Kerrigan et al, 2001; Kerrigan et al, 2002; Collins et al, 2002). 2001;76(5):503-510. } The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Treatment of adolescent gynecomastia. text-decoration: underline; Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Hoyos AE, Perez ME, Dominguez-Millan R, et al. right: 30px; 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. Reduction mammaplasty: Defining medical necessity. Three review authors undertook independent screening of the search results. Plastic Reconstruct Surg. Often times, insurance company will dictate how much breast tissue to be removed. Another set of breast pump supplies if you get pregnant . Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note Current concepts in gynaecomastia. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. .arrowPurpleSmall, a:hover.arrowPurpleSmall { The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). For medical 01/04/2023 Fagerlund A, Lewin R, Rufolo G, et al. Ann Plast Surg. A total of 90 patients underwent breast re-reduction surgery. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. 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). PDF Gender Dysphoria Treatment - Cigna Ann Plast Surg. 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. The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. 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. Annu Rev Med. Plastic Reconstruct Surg. Well-designed clinical trials provide reliable information about the effectiveness of an intervention, and provide valid information about the characteristics of patients who would benefit from that intervention. 2012;69(5):510-515. color: red!important; The Breast: Comprehensive Management of Benign and Malignant Diseases. 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 NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). 2018;7(Suppl 1):S70-S76. Quality of life after breast reduction. top: 0px; The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. color: blue!important; 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. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. 2014b;30(6):641-647. Blomqvist L, Eriksson A, Brandberg Y. What can I do if my insurance denies coverage for breast reduction? It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. 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. Computed tomography scan of adrenal glands to identify adrenal lesions.