padding-bottom: 4px; This may lead to additional scarring and additional operating time. Surg Laparosc Endosc Percutan Tech. 2015;10(8):e0136094. Aesthet Surg J. Flancbaum L, Choban PS. Plast Reconstr Surg. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Plast Reconstr Surg. 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. 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. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Reduction mammoplasty: Cosmetic or reconstructive procedure? Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? 1995;95(6):1029-1032. All the patients recovered well and were satisfied with the cosmetic outcomes. Patient demographics, surgical technique, and outcomes were analyzed. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. No other operation-related complications were observed. Plast Reconstr Surg. The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. The risks included infection, wound breakdown, scarring, and the need for re-operating. 2000;44(2):125-134. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. breast augmentation with implant. Miller AP, Zacher JB, Berggren RB, et al. Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. 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. color:#eee; Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Long-term functional results after reduction mammoplasty. Petty PM, Solomon M, Buchel EW, Tran NV. 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. color: red!important; OL OL OL OL OL LI { If an insufficient amount of breast tissue is removed, the surgery is less likely to be successful in relieving pain and any related symptoms from excessive breast weight (e.g., excoriations, rash). Many men with breast enlargement are found to have pseudo-gynecomastia. Disproportionately large breasts can cause both physical and emotional . Qu S, Zhang W, Li S, et al. } While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. Philadelphia, PA: W.B. Raispis T, Zehring RD, Downey DL. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. 2 . Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. No author listed. There were no statistically significant differences between the 2 vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Macromastia: all . Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Often times, insurance company will dictate how much breast tissue to be removed. 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). Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Plast Reconstr Surg. 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. 2017;35:157-161. There were no restrictions on the basis of date or language of publication. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. .strikeThrough { Townsend: Sabiston Textbook of Surgery. color: white; The mean age was 42.8 years (SD 19.5 years). Oxford, UK: National Health Service (NHS); October 2008. Reduction mammaplasty: An outcome study. Socioeconomic Committee Position Paper. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Ann Plast Surg. skin should not be excised horizontally below the inframammary fold. 2004;113(1):436-437. It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Obstet Gynecol Clin North Am. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. # font-weight: bold; #backTop { Handschin AE, Bietry D, Hsler R, et al. ul.ur li{ Also, there was no correlation between PR expression and 2D: 4D. text-decoration: underline; 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. 2006;118(4):840-848. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Plastic Reconstr Surg. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. color: blue!important; J Laparoendosc Adv Surg Tech A. 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. and areola. This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Blomqvist L, Eriksson A, Brandberg Y. Plast Reconstr Surg. Another set of breast pump supplies if you get pregnant . 2001;108(6):1591-1599. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. 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. Ann Plast 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. 2021;74(11):3128-3140. 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. 2013;71(5):471-475. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Breast Concerns of Adolescents. A study by Bruhlmann and Tschopp (1998) was a retrospective study of 246 patients from a surgical practice, approximately 50 % (132) of whom returned a questionnaire about their symptoms and satisfaction with aesthetic results, and their recollection of symptoms prior to surgery. Aesthet Surg J. They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. Mayo Clin Proc. 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. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. } Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia.

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