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). Ann Plast Surg. } The operation was successfully performed in all 20 patients with a mean operating time of 51 mins and a hospital stay of 4 days. OL OL LI { Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Plast Reconstr Surg. Gynecomastia: A systematic review. Plastic surgery for teenagers briefing paper. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. list-style-type: decimal; Reduction mammoplasty for macromastia. 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. list-style-type: lower-alpha; Copyright Aetna Inc. All rights reserved. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. 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. Reduction mammoplasty also known as breast reduction surgery, is a surgical procedure in women to reduce the weight, mass, and size of the breast. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. 1999;103(6):1687-1690. Reduction mammoplasty for asymptomatic members is considered cosmetic. Breast hypertrophy. Risk of bias was assessed independently by 2review authors. Can objective predictors for operative success be identified? Plast Reconstr Surg. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. 2021;74(11):3128-3140. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. } The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Patient demographics, surgical technique, and outcomes were analyzed. Ann Plast Surg. # color: white; Plastic Reconstruct Surg. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Thus, more than 1/3of operative subjects selected for inclusion in the study did not complete it; most of the operative subjects who did not complete the study were lost to follow-up. These preliminary findings need to be validated by well-designed studies. } Management of gestational gigantomastia. Plast Reconstr Surg. Plastic Reconstruct Surg. Plast Reconstr Surg. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. The authors (Nguyen et al, 2004) argue, based primarily on the results of the ASPS-funded BRAVO study (described below), that (with a single exception) no objective criteria for breast reduction surgery are supportable, including criteria based upon the presence of particular signs or symptoms, requirements based upon breast size or the amount of breast tissue removed, any minimum age limitations, any limitation based upon maximum body weight, requirements for a trial of conservative therapy, or the exclusion of certain procedures (liposuction). Oxfordshire NHS Trust. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. } color: blue!important; No author listed. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. World J Surg. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. 2018;24(6):1043-1045. Surgeon. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. An 18-question survey was created evaluating various aspects of BBR practice; UK and Irish plastic and reconstructive and breast surgeons were invited to participate by an e-mail containing a link to a web-based survey. Socioeconomic Committee Position Paper. 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. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. Because reduction mammoplasty may be used for both medically necessary and cosmetic indications, Aetna has set forth above objective criteria to distinguish medically necessary reduction mammoplasty from cosmetic reduction mammoplasty. 1998;26(1):61-65. A total of 244 out of 1,628 patients with the average age of 23.13 years. Hoyos AE, Perez ME, Dominguez-Millan R, et al. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. 2002;33:208-217. 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. } 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. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. 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%. Devalia HL, Layer GT. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Tang CL, Brown MH, Levine R, et al. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. 2018;7(Suppl 1):S70-S76. 2nd ed. Follow-up ranged from 2 months to 3 years. 2021 Aug 11 [Online ahead of print]. Last Review01/04/2023. Blomqvist L, Eriksson A, Brandberg Y. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. of the following criteria must be met: 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. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. } Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Plast Reconstr Surg. 2010;125(5):1301-1308. Li CC, Fu JP, Chang SC, et al. 2001;76(5):503-510. A population-level analysis of bilateral breast reduction: does age affect early complications? Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. 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. The study subjects were stratified into groups based on ages of <60 years and 60 years. background-color: #cc0066; Sollie (2018) noted that gynecomastia affects up to 2/3 of the male population. } ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Brown DM, Young VL. } Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. 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. Analysis was on an intention-to-treat basis. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Kerrigan CL, Collins ED, Kneeland TS, et al. 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].
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