Surgical treatment of primary gynecomastia in children and adolescents. 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). In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Surgical treatment is indicated when medical treatments fail. 2000;106(2):280-288. The condition not only must be unresponsive to dermatological treatments (e.g., antibiotics or antifungal therapy) and conservative measures (e.g., good skin hygiene, adequate nutrition) for a period of 6 months or longer, but also must satisfy criteria stated insection I above. This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. 1998;101(2):361-364. Laituri CA, Garey CL, Ostlie DJ, et al. OL OL LI { Schnur PL, Hoehn JG, Ilstrup DM, et al. 2014b;48(5):334-339. 2006;118(4):840-848. Kasielska-Trojan A, Danilewicz M, Antoszewski B. Scand J Plast Reconstr Hand Surg. A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. .newText { } } background: #5e9732; Setala L, Papp A, Joukainen S, et al. Often times, insurance company will dictate how much breast tissue to be removed. PDF Gender Dysphoria Treatment - Cigna Plast Reconstr Surg. The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from 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. and areola. CG-SURG-71 Reduction Mammaplasty - Anthem Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. A systematic search of the published literature was performed. color: blue Arlington Heights, IL: ASPS; March 9, 2002. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. 1996;20(5):391-397. Reduction mammoplasty: Criteria for insurance coverage. This may lead to additional scarring and additional operating time. Gland Surg. Annu Rev Med. Plastic Reconstruct Surg. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. bottom: 20px; Study subjects included 3538 patients with an average age of 43 years and body mass index of 31.6 kg/m(2) and most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes.The incidence of overall surgical complications was 5.1% and the incidence of major surgical complications was 2.1%. PDF Breast Reduction Surgery - Commercial Medical Policy - UHCprovider.com Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Level of Evidence = III. padding: 10px; Narula HS, Carlson HE. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Policy. Last Review01/04/2023. Guidelines for Adolescent Health Care. For individuals who received radiation treatment to the chest . There were only 2 studies of a total 25 patients that were considered as good in quality. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. J Pediatr Surg. Resolution of idiopathic gynecomastia may take several months to years. list-style-type: upper-alpha; Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. The health burden of breast hypertrophy. Breast Concerns of Adolescents. 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. 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. 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. display: none; In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. And if you are in Canada the surgeon decides. right: 30px; In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). 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. Hoyos AE, Perez ME, Dominguez-Millan R, et al. Measuring health state preferences in women with breast hypertrophy. Aetna considers breast reconstructive surgery to correct Seitchik MW. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. color: white; 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). Aetna's Itty Bitty Titty Committee - by Libby Watson - Sick Note breast augmentation with implant. 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. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Li CC, Fu JP, Chang SC, et al. Second, it is the burden of the proponent of an intervention to provide reliable evidence of its effectiveness, not the burden of ones whoquestion the effectivenessan intervention to provide definitive proof of ineffectiveness. Links to various non-Aetna sites are provided for your convenience only. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. 2019;166(5):934-939. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. 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. Plast Reconstr Surg. Kerrigan CL, Collins ED, Kneeland TS, et al. Arlington Heights, IL: ASPS; 2011. Devalia HL, Layer GT. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. .strikeThrough { Plast Reconstr Surg. No new trials were identified for this first update. Breast reduction surgery - Mayo Clinic Ann Plast Surg. 1995;95(6):1029-1032. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. 2020 Sep 4 [Online ahead of print]. Plast Reconstr Surg. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. 2017;35:157-161. 2008;32(1):38-44. Safran and colleagues (2021) noted that several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons. 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. 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. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Prostate Cancer Prostatic Dis. .newText { Khan SM, Smeulders MJ, Van der Horst CM. Plastic Reconstr Surg. Is breast reduction covered by health insurance? | ASPS Reduction mammoplasty for asymptomatic members is considered cosmetic. Many men with breast enlargement are found to have pseudo-gynecomastia. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. } Plast Reconstr Surg. display: block; These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). 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. Breast Reduction Surgery | Johns Hopkins Medicine Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. 2009;19(3):e85-e90. 1. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. A total of 244 out of 1,628 patients with the average age of 23.13 years. 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. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 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). background-color: #663399; Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes.
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