Auburndale Football Roster, Top Class Of 2025 Baseball Players, Cronus Zen Warzone Aimbot, Articles A

No data were provided on loss to follow-up. 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). Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Prostate Cancer Prostatic Dis. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. These studies did not find a relationship between breast weight or amount of breast tissue removed and the likelihood of response or magnitude of relief of pain after reduction mammoplasty. 2009;7(2):114-119. 2017;35:157-161. In other patients, excess skin and nipple and areola relocation are necessary. Oxfordshire NHS Trust. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Brown MH, Weinberg M, Chong N, et al. The health burden of breast hypertrophy. Macromastia: all . 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. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. 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. 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. 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. A total of 244 out of 1,628 patients with the average age of 23.13 years. Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. Kerrigan CL, Collins ED, Striplin D, et al. 1993;17(3):211-223. /* aetna.com standards styles for templates */ The end-point was the complete resolution of gynecomastia. 2017;139(6):1313-1322. Breast J. Aesthet Plastic Surg. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. J Laparoendosc Adv Surg Tech A. 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: OL OL OL OL OL LI { Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Surgery. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Plast Reconstr Surg. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. A lack of correlation between these variables may result from the fact that the analyzed group of men with idiopathic gynecomastia was small in number, but at the same time, it appeared to be homogenous in these aspects (positive ER and/or PR expression and high digit ratio). } Kasielska-Trojan A, Danilewicz M, Antoszewski B. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. PLoS One. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. 2014a;34(3):409-416. Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. 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. If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. Reduction mammoplasty: Cosmetic or reconstructive procedure? The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 2007;356(5):479-485. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. American Society of Plastic Surgeons (ASPS). J Plast Surg Hand Surg. Wound drainage after plastic and reconstructive surgery of the breast. No other operation-related complications were observed. N Engl J Med. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. #closethis { Women's Health and Cancer Rights Act of 1998. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . Plastic Reconstruct Surg. No new trials were identified for this first update. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. Annu Rev Med. For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). background-color: #cc0066; 2010;125(5):1301-1308. Sood R, Mount DL, Coleman JJ 3rd, et al. Ann Plast Surg. Current concepts in gynaecomastia. 2018;89(6):408-412. The mean age was 42.8 years (SD 19.5 years). Breast J. } 2009;62(2):195-199. color: red Oxford, UK: National Health Service (NHS); October 2008. Also, there was no correlation between PR expression and 2D: 4D. The primary outcome was the difference in wound drainage over 24 hours. Aetna considers magnetic resonance imaging (MRI), with or without contrast materials, of the breast medically necessary for members who have had a recent (within the past year) conventional mammogram and/or breast sonogram, in any of the following circumstances where MRI of the breast may affect their clinical management:. 1999;103(1):76-82; discussion 83-85. background-color: #663399; Howrigan P. Reduction and augmentation mammoplasty. Ann Plast Surg. Washington, DC: ACOG; 2011:121-122. The nipple-areola complex was re-positioned in 60 % of patients (n = 54). The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. Treatment of adolescent gynecomastia. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. 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. 1. Ann Plastic Surg. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. 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. Surgical treatment is indicated when medical treatments fail. } Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Plast Reconstr Surg. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. } Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Plast Reconstr Surg. Araco A, Gravante G, Araco F, et al. 2nd ed. Often times, insurance company will dictate how much breast tissue to be removed. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Completely autologous platelet gel in breast reduction surgery: A blinded, randomized, controlled trial. The authorsleave the reader with the conclusionthat decisions about the medical necessity of breast reduction surgery in symptomatic women should be left entirely to the surgeon's discretion. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Plast Reconstr Surg. } Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. 2021;147(5):1072-1083. 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. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. J Am Coll Surg. Level of Evidence = IV. 1997;185(6):593-603. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. Plast Reconstr Surg. To get insurance coverage, you'll probably need . First, the opinions and guidelines of medical professional organizations and consensus groups are considered according to the quality of the scientific evidence and supporting rationale. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Breast reduction outcome study. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. 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). 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. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Fischer S, Hirsch T, Hirche C, et al. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Plast Reconstr Surg. 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. 1990;24(1):61-67. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). The author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Ann Plast Surg. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. OL OL OL LI { 2007;119(4):1159-1166. Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . The study subjects were stratified into groups based on ages of <60 years and 60 years. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. 2008;53(3):255-261. Gland Surg. Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. Variations in pattern of pubertal changes in girls. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Endocrinol Metab Clin North Am. Reduction mammaplasty. cursor: pointer; Gynecomastia. 1998;101(2):361-364. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Scand J Plast Reconstr Hand Surg. skin should not be excised horizontally below the inframammary fold. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. GP Notebook. Patient demographics, surgical technique, and outcomes were analyzed. Three review authors undertook independent screening of the search results. Devalia HL, Layer GT. list-style-type: upper-alpha; background: #5e9732; } list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Anesthesia may be injected along with saline solution until the tissue is firm, and a suction cannula is used to extract fat from the breast. Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). Tang CL, Brown MH, Levine R, et al. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Aesthetic Plast Surg. 2001;76(5):503-510. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Statistical analysis was performed with student t-test and chi-square test. .fixedHeaderWrap { margin-top: 38px; Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Plast Reconstr Surg. The Mammotome procedure represented another novel therapeutic option for gynecomastia. 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. } This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. padding-bottom: 4px; However, it is unclear if there is any evidence to support this practice. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Level of Evidence = III. 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). cursor: pointer; All the patients recovered well and were satisfied with the cosmetic outcomes. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. display: none; Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. 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%. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. There were no restrictions on the basis of date or language of publication. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. } 1995;95(1):77-83. 2015;10(8):e0136094. outline: none; The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 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). 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. } Autorino R, Perdona S, D'Armiento M, et al. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Surgical treatment of primary gynecomastia in children and adolescents. See Appendix for Table 1. Khan SM, Smeulders MJ, Van der Horst CM. For individuals who received radiation treatment to the chest . 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. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Reduction mammaplasty provides long-term improvement in health status and quality of life. Policy Statement 6d: Aesthetic surgery procedures. Although the BRAVO study nominally included a "control group", there was no comparison group of subjects selected from the same cohort, who were randomized or otherwise appropriately assigned to reduce bias, and treated with conservative management according to a protocol to ensure optimal conservative care. Gynecomastia: A systematic review. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. 2013;71(5):471-475. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Grooving where the bra straps sit on the shoulder. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. 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. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. 1969;44(235):291-303. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Ages ranged from 18 to 66 years. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast.