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These investigators searched the literature on the treatment of Simon's grade I and II gynecomastia in PubMed, Scopus, Science Direct, and Cochrane using keywords "gynecomastia" and "liposuction". Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. Based largely upon these results, Nguyen et al (2004) reached the conclusion that a trial of conservative management is not an appropriate criterion for insurance coverage, even though responses to the BRAVO questionnaire indicated that operative candidates and hypertrophy controls received at least some pain relief from all of the conservative interventions, and for some conservative interventions, virtually all subjects reported at least some pain relief. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Gynecomastia may be drug-induced. Ann Plast Surg. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Hoyos AE, Perez ME, Dominguez-Millan R, et al. Evidence-based clinical practice guideline: Reduction mammaplasty. Level of Evidence = IV. color:#eee; They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). 2015;75(4):370-375. 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. Administration of Benefits and Transition Responsibilities Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Quality of life after breast reduction. } Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Plast Reconstr Surg. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Computed tomography scan of adrenal glands to identify adrenal lesions. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. 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. For medical 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. Washington, DC: ACOG; 2011:121-122. In other patients, excess skin and nipple and areola relocation are necessary. } Aesthet Surg J. 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. Fagerlund A, Lewin R, Rufolo G, et al. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. OL OL OL OL OL LI { 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. 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. 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. 40 . (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. J Plast Reconstr Aesthet Surg. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Breast reduction surgery, also known as reduction mammaplasty, removes fat, breast tissue and skin from the breasts. 2019;166(5):934-939. A cohort study of breast cancer risk in breast reduction patients. 2021;147(5):1072-1083. J Plast Reconstr Aesthet Surg. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Tang CL, Brown MH, Levine R, et al. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. 1997;100(4):875-883. Determinants of surgical site infection after breast surgery. Horm Res Paediatr. Breast Concerns of Adolescents. Treatment of adolescent gynecomastia. 2000;45(6):575-580. Major complications (1.6 %) included unilateral hematoma and localized infection. Plast Reconstr Surg. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. 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. text-decoration: underline; OL OL OL OL LI { Aesthetic Plast Surg. list-style-type: upper-roman; display: none; 1996;20(5):391-397. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Setala L, Papp A, Joukainen S, et al. 2012;130(4):785-789. Laituri CA, Garey CL, Ostlie DJ, et al. 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. Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. 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. 2014b;30(6):641-647. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). These preliminary findings need to be validated by well-designed studies. Kerrigan CL, Collins ED, Kim HM, et al. In: Townsend CM, Beuchamp RD, Evers BM, eds. 18th ed. 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. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. outline: none; Arlington Heights, IL: ASPS; March 9, 2002. 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. 2 . Fischer JP, Cleveland EC, Shang EK, et al. # color: white; 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. Araco A, Gravante G, Araco F, et al. There were only 2 studies of a total 25 patients that were considered as good in quality. In a systematic review, these investigators examined the role of radiotherapy in this context. Measuring health state preferences in women with breast hypertrophy. Scand J Plast Reconstr Hand Surg. color: white; 2020 Sep 4 [Online ahead of print]. 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). Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. 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. 2004;113(1):436-437. OL OL OL LI { Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Plastic Reconstruct Surg. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). border: none; Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass 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. skin should not be excised horizontally below the inframammary fold. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Ages ranged from 18 to 66 years. display: block; 2000;106(2):280-288. 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. 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. Marshall WA, Tanner JM. Level of Evidence = III. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. 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. J Laparoendosc Adv Surg Tech A. Plast Reconstr Surg. Vacuum-assisted minimally invasive surgery was carried out under general anesthesia; subjects were followed-up with physical examination and ultrasonography (US). } J Am Coll Surg. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Ann Plast Surg. 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. Safran T, Abi-Rafeh J, Alabdulkarim A, et al. padding: 10px; Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Note: Chronic intertrigo, eczema, dermatitis, and/or ulceration in the infra-mammary fold in and of themselves are not considered medically necessary indications for reduction mammoplasty. Ann Plast Surg. list-style-type : square !important; Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. } The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Post-operative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. 1990;24(1):61-67. 1995;95(6):1029-1032. 2002;33:208-217. Mental health care professionals may be consulted to address psychological distress from gynecomastia. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately. Qu S, Zhang W, Li S, et al. Reduction mammaplasty. position: fixed; Raispis T, Zehring RD, Downey DL. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Reduction mammoplasty for macromastia. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. 2005;55(3):227-231. Pediatr Surg Int. .headerBar { Leclere FM, Spies M, Gohritz A, Vogt PM. Hello! In these cases, breast reduction for men may take 2 to 3 hours. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Statistical analysis was performed with student t-test and chi-square test. Liposuction was also used adjunctively in all cases (average of 455 cc; range, 50 to 1,750 cc). Surgical treatment of gynecomastia: Complications and outcomes. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. Wound drainage after plastic and reconstructive surgery of the breast. 2014b;48(5):334-339. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. 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. The authors also noted that patients with BMI greater than 40 kg/m were significantly more likely to develop postoperative wound complications (p = 0.02). You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. Sood R, Mount DL, Coleman JJ 3rd, et al. Socioeconomic Committee Position Paper. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. Schnur PL, Hoehn JG, Ilstrup DM, et al. Breast reduction outcome study. There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). 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. Plastic Reconstr Surg. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. ol.numberedList LI { #closethis { } Breast pumps. N Engl J Med. Can objective predictors for operative success be identified? Aetna considers breast reconstructive surgery to correct 1999;103(6):1682-1686. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. No statistically significant differences in the drainage, level of pain, size of open areas, clinical appearance, degree of scar pliability, or scar erythema were noted. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. 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. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years). 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. Mayo Clin Proc. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. 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. bottom: 20px; color: blue!important; Am Surg. 1991;27(3):232-237. Surgical treatment is indicated when medical treatments fail. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Ann Plast Surg. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Plast Reconstr Surg. Khan SM, Smeulders MJ, Van der Horst CM. 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. 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. The average age was 24.7 years (range of 18 to 47 years). Asian J Surg. 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 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). z-index: 99; #backTop { ASPS clinical practice guideline summary on reduction mammaplasty. .fixedHeaderWrap { Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. Mizgala CL, MacKenzie KM. Breast hypertrophy. } The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. Last Review01/04/2023. Ann Chir Plast Esthet. 2007;119(4):1159-1166. Plast Reconstr Surg. Two review authors undertook independent data extraction of study characteristics, methodological quality and outcomes (e.g., infection, other wound complications, pain, and length of hospital stay [LOS]). Plast Reconstr Surg. Blomqvist L, Eriksson A, Brandberg Y. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. 2001;107(5):1234-1240. Plast Reconstr Surg. 1997;185(6):593-603. 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. 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. Gynecomastia has been classified into2 types. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. color: red Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Exposure to partners using estrogen containing vaginal creams; Cancer chemotherapy (alkylating agents, methotrexate, vinca alkaloids, imatinib, combination chemotherapy), Androgen receptor blockers - bicalutamide, 5 reductase inhibitors - finasteride, dutasteride, Angiotensin converting enzyme inhibitors (captopril, enalapril), Calcium channelblockers(diltiazem, nifedipine, verapamil), Anabolic steroids(e.g., in body builders). Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). 1998;49:215-234. } Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. 2001;76(5):503-510. /*margin-bottom: 43px;*/ It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. list-style-type: upper-alpha; Aesthetic Plast Surg. } Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? 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. 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. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. 2006;118(4):840-848. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Am J Infect Control. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. 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). of . Nelson et al (2014b) separately conducted a population level analysis of the 2005-2011 NSQIP datasets, identifying patient who underwent reduction mammoplasty, to determine the impact of obesity on early complications after reduction mammoplasty. Analysis was on an intention-to-treat basis. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. Subjects were compared to age-matched norms from another study cohort. 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). A non-standardized survey showed a very high satisfaction index. Reduction mammaplasty: An outcome study. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. The mean age was 42.8 years (SD 19.5 years). Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Petty PM, Solomon M, Buchel EW, Tran NV. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. top: 0px; Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. } Breast J. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. } Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. For many patients the psychological impact of the disease is substantial. However, these medications should be reserved for those with no decrease in breast size after 2 years. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Refer to the member's specific plan document for applicable coverage. Annu Rev Med. 1999;103(6):1674-1681. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. --> Surgical treatment of primary gynecomastia in children and adolescents. 2006;30(3):309-319. 2009;19(3):e85-e90. A total of 90 patients underwent breast re-reduction surgery. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. Plast Reconstr Surg. color: #FFF; No other operation-related complications were observed. Li CC, Fu JP, Chang SC, et al. 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. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast.