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Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 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. 1998;26(1):61-65. padding: 10px; Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. 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. display: none; A total of 15 articles met the inclusion criteria for review. Follow-up ranged from 2 months to 3 years. 2018;7(Suppl 1):S70-S76. No other operation-related complications were observed. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. The author concluded that the current level of evidence on this subject was very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. A population-level analysis of bilateral breast reduction: does age affect early complications? The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 1995;95(1):77-83. 2001;76(5):503-510. Saunders Co.; 1991. color: red 2021;74(11):3128-3140. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. There were only 2 studies of a total 25 patients that were considered as good in quality. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Fischer S, Hirsch T, Hirche C, et al. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. 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. Obstet Gynecol Clin North Am. Risk of bias was assessed independently by 2review authors. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Breast asymmetries: A brief review and our experience. The Breast: Comprehensive Management of Benign and Malignant Diseases. Breast Reduction Surgery | Johns Hopkins Medicine } 1999;103(6):1687-1690. He Q, Zheng L, Zhuang D, et al. 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). 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]. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. .fixedHeaderWrap { 2000;106(2):280-288. As explained below, the studies used to support the arguments for the medical necessity of breast reduction surgery are poorly controlled and therefore subject to a substantial risk of bias in the interpretation of results. 1994;21(3):539-543. Obesity and complications in breast reduction surgery: Are restrictions justified? cursor: pointer; list-style-type : square !important; 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. Gynecomastia has been classified into2 types. Does Health Insurance Cover Breast Reduction Surgery? - GoodRx } 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. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. padding-bottom: 4px; 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: In these cases, breast reduction for men may take 2 to 3 hours. Plast Reconstr Surg. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Breast reduction for symptomatic macromastia. 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. Ann Plast Surg. Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Leclere FM, Spies M, Gohritz A, Vogt PM. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). Prasetyono TOH, Budhipramono AG, Andromeda I, et al. width: 100%; 2008;32(1):38-44. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. 1999;103(6):1682-1686. Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. 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. J Plast Surg Hand Surg. 2014b;48(5):334-339. Analysis was on an intention-to-treat basis. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Gland Surg. 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. 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. 2nd ed. Washington, DC: ACOG; 2011:121-122. display: block; 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). Qu S, Zhang W, Li S, et al. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. 2011;128(4):243e-249e. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Copyright Aetna Inc. All rights reserved. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. A non-standardized survey showed a very high satisfaction index. # font-weight: bold; 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). Aesthetic Plast Surg. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Lonie S, Sachs R, Shen A, et al. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or 2006;118(4):840-848. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. 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.
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