A physician-supervised diet and exercise plan may be indicated in obese patients. 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. Aesthetic Plast Surg. However, it is unclear if there is any evidence to support this practice. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. In the case of breast reduction, however, for insurance purposes, it . display: none; Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Plast Reconstr Surg. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne Fagerlund A, Lewin R, Rufolo G, et al. 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. /*margin-bottom: 43px;*/ Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Treating providers are solely responsible for medical advice and treatment of members. 1996;20(5):391-397. Mistry RM, MacLennan SE, Hall-Findlay EJ. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. color: #FFF; Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. 2004;113(1):436-437. 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. color: blue!important; 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. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. margin-top: 38px; 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 . Surgical treatment is indicated when medical treatments fail. A follow-up study of 105 women with breast cancer following reduction mammaplasty. Hoyos AE, Perez ME, Dominguez-Millan R, et al. These investigators searched the literature on the treatment of Simon's grade I and II gynecomastia in PubMed, Scopus, Science Direct, and Cochrane using keywords "gynecomastia" and "liposuction". Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. 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. Current concepts in gynaecomastia. Plast Reconstr Surg. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 1.3 cm versus 0.8 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 2.4 days versus 3.1 1.6 days, p < 0.001). Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. (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. 2009;19(3):e85-e90. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; 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. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. } Patients with abnormal histopathology could not be pre-operatively identified based on demographics. } The nipple-areola complex was re-positioned in 60 % of patients (n = 54). Level of Evidence = IV. 2005;55(3):227-231. 2009;62(2):195-199. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review Other just require 500 grams no matter what your height and weight. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. .newText { Townsend: Sabiston Textbook of Surgery. Reduction mammaplasty. color: white; Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Ann Plast Surg. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Obesity and complications in breast reduction surgery: Are restrictions justified? Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. This will be computed based on your body area. However, these medications should be reserved for those with no decrease in breast size after 2 years. border-width:0; Breast J. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). 2014;20(3):274-278. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. For individuals who received radiation treatment to the chest . These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. Refer to the member's specific plan document for applicable coverage. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. width: 100%; .fixedHeaderWrap { Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Wound drainage after plastic and reconstructive surgery of the breast. 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. 2 . breast augmentation with implant. Another set of breast pump supplies if you get pregnant . 2007;36(2):497-519. 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. With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an out-patient; however, this was not statistically significant (p = 0.07). Plast Reconstr Surg. Gynecomastia in patients with prostate cancer: Update on treatment options. Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. Gynecomastia: A systematic review. Type II gynecomastia is more generalized breast enlargement. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Plast Reconstr Surg. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. Plast Reconstr Surg. 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). All patients underwent routine investigations to exclude secondary causes of gynecomastia. Surg Laparosc Endosc Percutan Tech. 2015;75(4):370-375. 2012;69(5):510-515. color: red 2003;111(2):688-694. height:2px; 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. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . } Hello! The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Plast Reconstr Surg. 2000;44(2):125-134. 2014a;34(1):66-73. 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. Seitchik MW. background-color:#eee; Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days.
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