Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. Mistry RM, MacLennan SE, Hall-Findlay EJ. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. Plast Reconstr Surg. Grooving where the bra straps sit on the shoulder. The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Schnur PL, Schnur DP, Petty PM, et al. 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. Plast Reconstr Surg. Plastic Reconstr Surg. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. 1996;20(5):391-397. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. bottom: 20px; Reduction mammoplasty for asymptomatic members is considered cosmetic. Breast Reduction Surgery: Procedure, Recovery, Cost, and More - Healthline } World J Surg. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. 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? Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for 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]. 2000;45(6):575-580. 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. Other just require 500 grams no matter what your height and weight. A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. 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. However, these medications should be reserved for those with no decrease in breast size after 2 years. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. 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. Collis N, McGuiness CM, Batchelor AG. Kasielska-Trojan A, Danilewicz M, Antoszewski B. right: 30px; A detailed physical examination, including testicular examination. Conversely, many patients believe if a procedure is considered cosmetic, it is not a medically indicated and covered procedure. Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. ASPS Recommended Coverage Criteria for Third Party Payors. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Reduction mammoplasty for macromastia. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Evidence-based clinical practice guideline: Reduction mammaplasty. Handschin AE, Bietry D, Hsler R, et al. This Clinical Policy Bulletin may be updated and therefore is subject to change. 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. Fagerlund A, Lewin R, Rufolo G, et al. 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. Oxford, UK: National Health Service (NHS); October 2008. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. OL OL LI { Prepubertal gynecomastia linked to lavender and tea tree oils. Plast Reconstr Surg. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Mizgala CL, MacKenzie KM. /*margin-bottom: 43px;*/ The majority (87.7 %) of cases presented with accompanying mastalgia. 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. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Ann Plast Surg. A cohort study of breast cancer risk in breast reduction patients. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. 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. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. How to Get Your Breast Reduction Covered By Insurance - RealSelf News A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. li.bullet { Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. 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. Surgical management of gynecomastia--a 10-year analysis. 2001;107(5):1234-1240. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. 2018;7(Suppl 1):S70-S76. 2013;71(5):471-475. 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 . The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. Mental health care professionals may be consulted to address psychological distress from gynecomastia. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. ASPS clinical practice guideline summary on reduction mammaplasty. 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. 2002;109(5):1556-1566. The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. Glatt BS, Sarwer DB, O'Hara DE, et al. 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. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). Devalia HL, Layer GT. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Kalliainen LK; ASPS Health Policy Committee. color:#eee; The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Surgery. Plastic Reconstr Surg. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Surgical treatment of gynecomastia: Complications and outcomes. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. (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.
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