Category Archives: Reduction mammoplasty

Breast Reduction: Procedure, Risks, Benefits, Recovery

Surgery Overview

Breast reduction surgery (reduction mammoplasty)Breast reduction surgery (reduction mammoplasty) removes some of the tissue and skin from the breasts to reshape and reduce the size of the breasts. It can also make the area of dark skin surrounding the nipple (areola) smaller.

To remove tissue and skin from the breast, the surgeon first makes one or more cuts in the breast. After the excess tissue and skin have been removed, the skin is closed with stitches. Sometimes the nipple and areola have to be removed and repositioned.

Sometimes liposuction is used along with surgery. If most of the breast is fatty tissue and if excess skin isn’t a problem, liposuction alone may be enough for breast reduction.

Breast reduction surgery is done in a hospital or surgical center, typically with general anesthesia. The surgery usually takes 3 to 5 hours. An overnight stay is not usually required. For smaller reductions, the surgery may be done with local anesthesia.

Breast lift (mastopexy)Breast lift (mastopexy) is similar to a breast reduction, except that in some cases only skin is removed. A breast lift can raise sagging or drooping breasts, which is a common problem with large, heavy breasts, and can elevate the nipple and areola.

Immediately after surgery, gauze is placed over the incisions, and the breasts are wrapped in an elastic bandage or supported with a special surgical bra. In some cases, there may be a small tube in each breast to help drain blood and fluid for the first couple of days. Stitches may be removed in 1 to 2 weeks.

Most women have some breast pain for the first few days after surgery and then milder discomfort for a week or longer. Medicine can help relieve the pain. Swelling and bruising may last for several weeks. Wearing a surgical bra 24 hours a day can help reduce swelling and support the breasts while they heal.

You will likely resume your normal work and social activities within a couple of weeks, unless those activities involve heavy lifting or strenuous exercise. You may need to avoid more vigorous exercise and activities for 3 to 4 weeks or more. It’s important to wear a bra that supports the breasts well, such as a sports or athletic bra.

You will have visible scars on your breasts after breast reduction surgery. These are almost always in areas that can be covered by a bra or swimsuit. Scars may fade over time, but they will not disappear.

Breast reduction surgery is done to change the size, weight, firmness, and shape of the breasts. You may decide to have breast reduction surgery to:

Women who have breast reduction surgery are often extremely satisfied. It can make the breasts smaller, firmer, lighter, and more evenly proportioned. It usually relieves the physical discomfort and pain caused by large breasts.

The results of breast reduction surgery are considered permanent. But the breasts may become larger or their shape may change as a result of pregnancy, weight gain, or weight loss.

The most common risks of breast reduction surgery include:

Less commonly, damage to the breast’s blood supply may occur during surgery. This may delay the skin’s healing process. Loss of part or all of the nipple and areola can also occur, but this is not common.

Other risks of surgery include:

These risks can be serious or even life-threatening, but they rarely occur.

Keep in mind that breast reduction may make breastfeeding difficult or impossible in the future. Some women may still be able to breastfeed after having reduction surgery.

If you are thinking about having a breast reduction, contact your insurance company. Some insurance companies cover some or all of the costs of breast reduction surgery if surgery is being done to relieve back pain, skin problems, or other medical problems caused by large or heavy breasts. They typically will not cover breast reduction surgery being done solely to change the appearance of the breasts, because it is not considered a medically necessary procedure when done for this reason.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

ByHealthwise StaffPrimary Medical ReviewerAnne C. Poinier, MD – Internal MedicineSpecialist Medical ReviewerKeith A. Denkler, MD – Plastic Surgery

Current as ofFebruary 20, 2015

Continued here:
Breast Reduction: Procedure, Risks, Benefits, Recovery

Mammographic Findings Following Reduction Mammoplasty …

Breast reduction mammoplasty is becoming an increasingly common procedure. A baseline mammogram is recommended after 35 years of age as the most effective method for detection of small breast cancers. A prospective study was conducted for the evaluation of the mammographic findings after reduction mammoplasty. During the last 7 years, 113 patients over 35 years of age underwent bilateral reduction mammoplasty. All patients had a preoperative mammogram. A new mammogram was obtained at 6 and 18 months after the procedure. All films were reviewed by the same two radiologists. Breast reduction was performed with the vertical bipedicle flap technique (McKissock) and the inferior pedicle technique. There were no apparent differences in the findings between the two methods. Most common findings were parenchymal redistribution in 102 (90.2%) and elevation of the nipple in 96 (84.9%), produced by a shift of the breast tissue to a lower position. Calcifications were seen in 29 (25.6%), and “oil cysts” in 22 (19.4%), caused by localized fat necrosis. A retroareolar fibrotic band was found in 23 (20.3%), from the transposed flap. Areolar thickening was observed in six (5.3%), and skin thickening in only two (1.7%), from scar tissue. Mammographic findings after reduction mammoplasty are predictable, thus preventing unnecessary biopsies and making the diagnosis of lesions unrelated to the procedure easier. All patients over 35 years of age should have a preoperative and a postoperative mammogram for future reference.

Key words: Breast reduction Mammography Breast cancer

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2001 Springer-Verlag New YorkInc.

Excerpt from:
Mammographic Findings Following Reduction Mammoplasty …

Reduction mammoplasty for macromastia | SpringerLink

Macromastia is a common cause of physical and emotional suffering. Reduction mammoplasty can provide relief from shoulder grooving, back and neck pain, intertrigo, and symptoms of ulnar nerve compression. Similarly, emotional well being is enhanced by improved self-image, increased capacity to participate in sports and work, and the ability to wear normal, attractive clothes. In the last three years, we have performed reduction mammoplasty using the inferior pedicle technique or free nipple graft in 75 patients. Preoperative symptoms typically included back pain, shoulder grooving, and a stooped posture. Fat necrosis was the most common complication and was associated with large resections. Patient satisfaction was high for both procedures.

Key wordsMacromastiaBreastNippleMammoplasty

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1.

Ariyan S: Reduction mammaplasty with a nipple-areola carried on a single, narrow inferior pediole. Ann Plast Surg d5

7, 1980

2.

Bolger WE, Seyfer AE, Jackson SM: Reduction mammaplasty using the inferior glandular pyramid pedicle: experiences with 300 patients. Plast Reconstr Surg

75, 1987

3.

Brown FE, Sargent SK, Cohen SR, et al: Mammographic changes following reduction mammaplasty. Plast Reconstr Surg

691, 1987

4.

Conway H: Weight of breasts as handicap to respiration. Argument for reduction mammaplasty. Am J Surg

674, 1962

5.

Courtiss EH, Goldwyn RM: Breast sensation before and after plastic surgery. Plast Reconstr Surg

1, 1976

6.

Crepau R, Klein HW: Reduction mammaplasty with inferiorly based glandular pedicle flap. Ann Plast Surg

463, 1982

7.

Georgiade MG, Serafin T, Morris R, et al: Reduction mammaplasty utilizing the inferior pedicle nipple-areola flap. Ann Plast Surg

211, 1979

8.

Goin K, Goin J, Gianini H: The psychic consequences of a reduction mammoplasty. Plast Reconstr Surg

533, 1977

9.

Goldwyn RM: Reduction Mammoplasty. Boston: Little, Brown, 1990, p xi

10.

Isaacs G, Rozner L, Tudball C: Breast lumps after reduction mammaplasty. Ann Plast Surg

394, 1985

11.

Kallen R, Broome A, Muhlow A, et al: Reduction mammoplasty: results of preoperative mammography and patient inquiry. Scand J Plast Reconstr Surg

(3):303, 1986

12.

Kaye BL: Neurologic changes with excessively large breasts. South Med J

177, 1972

13.

Labandter HP, Dowden RV, Dinner NI: The inferior segment technique for breast reduction. Ann Plast Surg

493, 1982

14.

McKissock PK: Reduction mammaplasty. In: Courtiss EH (ed): Aesthetic Surgery. Trouble: How to Avoid It and How to Treat It. St. Louis: C.V. Mosby, 1978, pp 189203

15.

McKissock PK: Complications and undesirable results with reduction mammaplasty. In: Goldwyn RM (ed): The Unfavorable Result in Plastic Surgery: Avoidance and Treatment, 2nd ed. Boston: Little, Brown, 1984, pp 739759

16.

Miller CL, Feig SA, Fox JW IV: Mammographic changes after reduction mammoplasty. Am J Roentgenol

35, 1987

17.

Pitanguy I: Reduction mammoplasty: a personal odyssey In: Goldwyn RM (ed): Reduction Mammoplasty. Boston: Little, Brown, 1990, p 95128

18.

Reus WF, Mathes SJ: Preservations of projection after reduction mammaplasty: long-term follow-up of the inferior pedicle technique. Plast Reconstr Surg

644, 1988

19.

Silversmith PE, Crepau R: Reduction mammaplasty. Ann Plast Surg

266, 1983

20.

Strombeck JL: Reduction mammaplasty by Strombeck Technique. In: Goldwyn RM (ed): Plastic and Reconstructive Surgery of the Breast. Boston: Little, Brown, 1976, p 209

21.

Zelnick JN, Pearl RM, Johnson D: Use of an axial flap for reduction mammaplasty. Ann Plast Surg

204, 1981

Springer-Verlag New York Inc.1993

Continued here:
Reduction mammoplasty for macromastia | SpringerLink

Reduction mammoplasty by the total dermoglandular pedicle …

The use of a total dermoglandular pedicle in 700 cases of reduction mammoplasty are described by this team of authors. They emphasize that their modification of the dermoglandular pedicle provides an extremely reliable blood supply to the areola and is quick and easy to perform. There is no anesthesia of the nipple postoperatively, and the shape of the breast is favorable both in the immediate postoperative period and over the longterm follow-up observation between the years 1979 and 1984.

Key wordsBreastReduction mammoplastyTotal dermoglandular pedicle

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1.

Aufricht F: Mammoplasty for pendulous breasts: Empiric and geometric planning. Plast Reconstr Surg

:13, 1949

2.

Balch CR: Central mound technique for reduction mammoplasty. Plast Reconstr Surg

:305, 1981

3.

Biesenberger H: Eine neue Methode der Mammoplastrik. Zentralbl Chir

:382, 1928

4.

Dufourmentel C, Mouly R: Plastie mammaire par la mthode oblique. Ann Chir Plast

:45, 1961

5.

Lalardie JP, Jouglard P: Chirurgie plastique du Sein. Paris: Masson, 1974

6.

McKissock PK: Reduction mammoplasty with a vertical flap. Plast Reconstr Surg

:245, 1971

7.

Mitz, V, Lassau JP: Vascularisation du Sein. Etude des rapports entre les vascularisations artrielles glandulaires et cutanes du sein. Arch Anat Pathol

:365, 1973

8.

Moufarrege: Plastic mammaire pdicule dermoglandulaire infrieur. Ann Chir Plast

:249, 1982

9.

Pitanguy I: Une nouvelle technique de plastie mammaire: tude de 245 cas conscutifs et prsentation d’une technique personnelle. Ann Chir Plast

:199, 1962

10.

Regnault P: Reduction mammoplasty by the B technique. Plast Reconstr Surg

:79, 1960

11.

Reich J: The advantage of a lower central breast segment in a reduction mammoplasty. Aesth Plast Surg

:47, 1979

12.

Robbins T: A reduction mammoplasty with the areola nipple based on an inferior dermal pedicle. Plast Reconstr Surg

:64, 1977

13.

14.

Strombeck JO: Mammoplasty: Report of a new technique based on the two-pedicle procedure. Br J Plast Surg

:79, 1960

15.

Thorek M: Plastic Surgery of the Breast and Abdominal Wall. Springfield, Ill, Charles C Thomas, 1942

Springer-Verlag1985

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Reduction mammoplasty by the total dermoglandular pedicle …

Minneapolis Breast Reduction: Mammoplasty | Edina Plastic …

Women with large, pendulous and heavy breasts may experience a variety of medical problems caused by excessive weight of the breasts. Back and neck pain, skin irritation, bra strap grooving and postural problems are only some of the issues. Other common problems are restriction of physical activities, difficulty with clothes fitting well and feeling socially self-conscious.

Breast reduction surgery (also called reduction mammoplasty) is a procedure designed to reduce the breast size and weight. For breasts that are wider, longer and larger than ideal, breast reduction surgery will reduce these variables. The procedure removes breast glands, skin and fat, and can reduce areolar diameter. The breast will be lighter, smaller, firmer and more in proportion to the rest of the body.

Most women opting for breast reduction have breast size that is out of proportion to the rest of their body. In addition, patients who want a very active lifestyle find their breast size can interfere with comfort during movement. Breast reduction surgery is the answer to these issues. In most cases, breast reduction is performed on the fully mature breast or after a woman is at least 18 years in age. The procedure may be done at a younger age in cases of extreme early and robust breast development.

Your surgeon will ask about your medical history and your goals for breast reduction. Insurance covers this procedure in many cases and documenting medical problems associated with large breasts is important. Other criteria must be met for coverage, such as height, weight, the amount of breast tissue to be removed and previous non-surgical treatment methods. The insurance company has criteria for approval that you can request by calling your insurance carriers customer service.

During your initial examination, your surgeon will discuss options for surgery techniques and what you could expect for results. Age, skin laxity, weight and tissue quality all affect the procedure results and recovery.

Your surgeon may require a pre-surgery mammogram and a physical exam by your primary care physician to assure you are medically ready for surgery. Arrange for an adult to drive you home after surgery. You will also need an adult to stay with you the first night.

> Our tips for preparing for your surgery are available here.

Breast reduction is a complex procedure. Our surgeons at Edina Plastic Surgery have successfully performed this surgery for hundreds of patients. We have a special expertise in reduction mammoplasty and are board certified in the specialty of plastic surgery.

As with any surgery there are certain risks. Bleeding, infection, skin or nipple tissue loss, delayed healing and reactions to anesthesia are some of the possible surgery complications but they are not typical or common. General anesthesia is used during the procedure and local anesthesia blocks can be used for post-surgery patient comfort. This procedure is done in our modern and accredited outpatient surgery center, which is attached to our clinic.

Your surgeon will use scar reduction techniques like careful suturing, tape support and, on occasion, a topical cream. Scars will fade in color and intensity over time generally one to two years. You should know, however, that breast reduction is a trade of large and heavy breasts for a more manageable size and shape with incisions and subsequent scars.

Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. Skin from both sides of the breast is moved down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.

In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may need to be completely removed and grafted into a higher position. This will result in a loss of sensation in the nipple and areolar tissue.

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. When only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars although this is not covered by insurance.

After surgery, you will be placed in an elastic bandage and gauze, or perhaps a post-surgical bra over gauze dressings. Typically no drains are used, but occasionally they are needed. Discomfort can be managed with prescribed pain medications. A brief course of antibiotics is also prescribed. You will return for a follow-up exam in one to three days.

Most patients return to work in about one week and can resume other normal activities in four to six weeks. After a week of rest and recovery, other activities can be gradually increased as tolerated. A sports bra or other good support garment may be the most comfortable during recovery, but that is a personal preference. Most swelling will subside in six to eight weeks; some swelling can linger for up to a year. Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Fluctuations may continue in response to your hormonal shifts, weight changes and pregnancies.

Your surgeons techniques will make your scars as inconspicuous as possible. Its important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months before gradually becoming less obvious, sometimes fading to thin white lines. The scars can usually be placed so that you can comfortably wear low-cut tops.

As much as you may have wanted and hoped for these changes, youll need time to adjust to your new image. So will your family and friends. Be patient with yourself, and with others. Keep in mind your original goals for this surgery.

Most women are very pleased with the surgery results. Of all the plastic surgery procedures, breast reduction results in the quickest body-image changes. Youll be rid of the physical discomfort of large breasts, your body will look better proportioned and clothes will fit you better.

Before

After

Before

After

28 yo, 5 7, 150 lbs. Removed 400 grams from right breast and 362 grams from left breast. Photos 4 months post op.

Before

After

60 yo woman, photos 4 months post op.

Before

After

35 yo, 5 4, 162 lbs. Removed 770 grams from left breast and 497 grams from right breast.

Before

After

32 yo,breast reduction with breast lift. Post-op photos at 8 months.

Before

After

37 yo, 56, 170 lbs. Bilateral reduction mammoplasty. Right side resection 950 grams, left side resection1,156 grams. 10 week photos.

Before

After

47 yo, 57, 195 lbs. Bilateral breast reduction by central pedicle technique. 786 grams from right, 834 grams from left. 6 week photos.

Before

After

52, 137 lbs.Mastopexy/small breast reduction right side resection weight 177 grams, left side 182 grams. 2 month post-op photos.

Before

After

30 yo,55, 205 lbs. Patient history of back pain. 900 grams from right breast, 1100 grams from left breast. 3 month post op photos.

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Minneapolis Breast Reduction: Mammoplasty | Edina Plastic …

| Plastic Surgery Center & Spa Breast Reduction &laquo

Breast reduction not only improves the size, but also the shape, of overly large breasts. The condition of oversized breasts is called breast hypertrophy. Breast hypertrophy may develop at any time: at puberty, during teenage growth years, or after childbirth. The condition often causes problems such as back pain, bra strap pain and irritation of the skin under the breasts. Patients with very large breasts may have difficulty with physical activities such as tennis or jogging. They also may have problems dressing, particularly in todays popular athletic wear.

Patients as young as 14 and as old as 70 have had successful breast reduction. In younger patients, the surgery may be performed once breast size has been stable for at least one year. When breast hypertrophy is significant, insurance may cover some or all of the costs of surgery, however our office does not participate with any insurance.

Breast hypertrophy is characterized by three anatomic problems:

excessive glandular tissue;

excessive and/or loose skin over the gland; and

low placement of the nipple areolar complex.

Breast reduction surgery (reduction mammoplasty) corrects all three by reducing the size of the gland, repositioning the nipple and reshaping the breast.

Based on your age and breast size, the surgeon chooses one of several possible techniques to reposition the nipple. Then, a portion of the glandular tissue is removed and the loose skin tightened to support and shape the reduced breast. The resulting scars are located around the nipple and in front of and under the breast, in the breast crease.

Reduction mammoplasty usually is performed on an outpatient basis or with a one-night hospital stay. After surgery, a large, bulky dressing will be placed around your chest, and a small tube, called a drain, may be used to remove blood or fluid (serum) from the surgical area. The dressing will be changed and the drain removed two or three days after surgery. You will be given a soft postoperative bra to wear continuously for three weeks, except during bathing.

You should not wear underwire bras or participate in impact exercises or athletics during this time. Patients usually return to work, school or other routines 10 to 14 days after surgery.

Complications from reduction mammoplasty are unusual. Occasionally, there may be a change in nipple sensation, but this is usually temporary. There have been rare instances of nipple damage.

Click here for more before-and-after Breast Reduction photos.

Visit our plastic / cosmetic surgery office located in Portland, Maine (ME).

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| Plastic Surgery Center & Spa Breast Reduction &laquo

St. Louis Breast Reduction | Breast Reduction Surgery in …

Parkcrest Plastic Surgery and its team of board-certified physicians welcome breast reduction patients from throughout the region, including St. Louis, St. Charles, Chesterfield, OFallon, St. Peters, Creve Coeur, and surrounding areas. Our vast experience and warm demeanor set us apart, making our office the best choice for breast reductions in St. Louis.

Details: Patient underwent Breast Reconstruction of the right breast using Style 410 implant.

Details: Patient underwent Bilateral Breast Reconstruction surgery.

Breast reduction, or reduction mammoplasty, reduces the size of large breasts for medical or cosmetic reasons. The goal is to ease a womans self-consciousness and physical discomfort while giving her a more attractive contour with breasts that are in proportion with her body.

Various medical problems are associated with very large breasts. These include back and neck pain, skin irritation, skeletal deformities, and breathing problems. Large, heavy breasts also contribute to poor posture and can interfere with activities such as exercise or swimming.

Parkcrest Plastic Surgery has helped hundreds of women in St. Louis, St. Charles, and Chesterfield with their breast reduction procedures. We have years of experience serving the St. Louis area, so we know how important high-quality plastic surgery is to our patients. We believe the best patient is a well-informed patient, so we provide you with procedure details, breast reduction before and after photos, and typical breast reduction prices. Breast reduction is commonly covered by insurance. The staff at Parkcrest Plastic Surgery will assist you in obtaining preauthorization.

The doctors and staff strive to be professional and efficient while providing a warm caring atmosphere in the office. If you are considering a breast reduction in St. Louis, then please book a consultation today with Parkcrest Plastic Surgery.

Breast reduction is done under general anesthesia on an outpatient basis or with an overnight stay. The surgery removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. During a breast reduction procedure, you can also reduce the size of the areola, the darker skin surrounding the nipple.

The procedure starts with incisions made around the pigmented nipple-areolar complex and extending vertically below the nipple and in the fold under the breast. The nipple-areolar complex is moved upward to the desired location. After the breast reduction procedure, your surgeon will then cover the incisions with a light dressing.

The result of the breast reduction operation may be further enhanced by liposuction of the axillary area to reduce excess fat deposits.

When performed by a qualified plastic surgeon, breast reduction procedures are quite safe. Nevertheless, as with any surgery, there is always a possibility of complications. During your evaluation, the physicians at Parkcrest Plastic Surgery will make sure you are aware of any potential problems. You can reduce your risks by closely following your physicians advice both before and after breast reduction surgery.

After your breast reduction, you will be placed in a surgical bra that will support your breasts during initial healing. You will feel tender, stiff, and sore for a few days, but the discomfort can be controlled with oral medications. There will be swelling and, depending on the patient, some bruising. The procedure may reduce feeling in the nipple as well as eliminate the ability to breastfeed.

Most breast reduction patients will be back to work within three weeks. You will notice some immediate results of the surgery and see continued improvement for about six to 12 months. Your scar will usually fade in six to 18 months.

At the Parkcrest Plastic Surgery office, Dr. David A. Caplin, Dr. Melvin Maclin, and Dr. Patricia McGuire offer plastic and reconstructive surgery to patients across Eastern Missouri including St. Charles, Chesterfield, OFallon, St. Peters, and Creve Coeur.Contact the Parkcrest Plastic Surgery office today to schedule your breast reduction consultation!

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St. Louis Breast Reduction | Breast Reduction Surgery in …

Breast Reduction Surgery | BreastReduction4You.com

Whenit comes to breasts, bigger is not always better in fact, it can be a nightmare. Overly large breasts can inflict physical discomfort and psychological frustration. They “get in the way”, making it difficult to exercise and play sports, and their weight can cause pain by straining neck and back muscles. When a young woman develops very large breasts, she is often the brunt of ridicule and harassment throughout high school and beyond. And let’s not even get started with fit problems when shopping for stylish clothes!

While most of the attention seems to focus on women who choose to supplement what they have with implants, each year a substantial number of their sisters choose to have their breasts reduced in size. In 2006 alone, 104,455 breast reduction procedures were performed in the United States, according to the American Society of Plastic Surgeons. That number was enough to rank the breast reduction fifth overall in reconstructive procedures that year, up 23 percent over 2000.

Breast reduction surgery, also known as reduction mammoplasty (or mammaplasty), reduces the weight, mass and size of the breasts for whatever reason. Its goal is to alter the size of the breasts to improve the life of the individual.

Several factors must be weighed to determine if reduction mammoplasty is an option for you. First and foremost, you must be in good health, with no active diseases or pre-existing medical conditions. Your skin must have good elasticity so that it can bounce back postsurgery to its former tightness. You must have realistic expectations of the outcome of your surgery, so communication with your plastic surgeon is critical to achieving optimal results.

We have created this site to give you as much information as possible about breast reduction. You need to be informed about the procedure, which is major surgery, and you need to know what your options are. Make sure to do plenty of research before you select a plastic surgeon to perform your procedure.

Excerpt from:
Breast Reduction Surgery | BreastReduction4You.com

About Breast Reduction Surgery | BreastReduction4You.com

Breast Anatomy and Development

Before having breast reduction surgery, learn about breast anatomy and development.

What is Breast Reduction and Are You a Candidate?

Is breast reduction right for you? Learn how to tell if you are a candidate.

Common Reasons for Wanting Reduction Mammaplasty

Some of the popular reasons why women chose to undergo breast reduction surgery.

Ptosis Levels and Safe Volume Removal

Learn the various levels of breast ptosis, and how much tissue is safe to remove.

The Kindest Cut: Various Techniques, Their Incisions and Breast Reduction Scars

Read about the breast reduction techniques and incisions that are used so you can get an idea of what kind of scars you may have.

Breast Reduction Complications and Risks

Know breast reduction complications and risks before you commit to surgery.

Frequently Asked Questions (FAQ) About Reduction Mammoplasty

Common questions about breast reduction surgery.

Breast Feeding After Breast Reduction: Is It Possible?

Learn about breastfeeding after reduction mammoplasty.

Areola Reduction Surgery

Learn about areola reduction surgery, and if it’s right for you.

Nipple Reduction Surgery

Info on nipple reduction surgery. Are you a candidate?

Areola Micropigmentation for Scars

Options in micropigmentation to mask scars after surgery.

An Introduction to Anesthesia

What you should know about anesthesia before you undergo breast reduction surgery.

Costs of Breast Reduction Surgery

What to expect in terms of costs for breast reduction.

Breast Reduction Photo Gallery

Before-and-after breast reduction pictures.

Breast Reduction Patient Journals

Browse reduction mammoplasty patient journals to read personal experiences with the surgery.

How to Choose a Good Breast Reduction Surgeon

Learn how to make sure you find the right surgeon for your breast reduction.

United States Breast Reduction Surgery Centers

Find a breast reduction surgeon near you.

Researching Your Plastic Surgeon

Learn how to research plastic surgeons to help you decide which one is best for your reduction mammoplasty.

Preparing for Your Consultation

What to expect at your consultation appointment, as well as how to prepare and questions to ask your surgeon.

Your Consultation Appointment: What to Expect

What you can expect at your breast reduction consultation appointment.

Breast Reduction Consultation Fees

Consultation fees that you may have to pay.

Preparing for Your Breast Reduction Surgery

Tips on how to prepare yourself and your home for your breast reduction surgery.

Medications and Supplements to Avoid Before and After Surgery

A list of medications that you should avoid before and after your reduction mammoplasty.

Mammograms and Breast Self Exam

Read about mammograms and how to give yourself a self breast exam.

Surgery Day at Last!

What you can expect on your breast reduction surgery day.

How the Breast Reduction Surgery is Performed

Get an idea of how reduction mammoplasty is performed.

Your Postoperative Appointments

Prepare for your follow-up appointments after breast reduction.

In The Months Ahead

Things to keep in mind during the months after surgery.

Revision Breast Reduction Surgery

What you should know about revision breast reduction.

Important Bra Sizing Information

After breast reduction surgery, how do you know what size you are? How to measure and find the right size.

More questions? Post on our discussion forum.

Breast Reduction and Other Plastic Surgery Links

Additional information on breast reduction and plastic surgery.

Contact Information

Contact us!

Miscellaneous Information

Mission statement, link to discussion forum, and contact page.

Recovery: What to Expect

What you can expect during your breast reduction recovery.

Recovery Information

Reduction mammoplasty recovery information.

Postoperative Care Guidelines (Print Out)

Printable guide to postoperative care.

Surgery Preparation Print Out

Printable checklist to keep track of things while you prepare for your breast reduction surgery.

To learn more about other elective procedures, such as rhinoplasty, or how to find a local board certified plastic surgeon, visit Consumer Guide to Plastic Surgery.

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About Breast Reduction Surgery | BreastReduction4You.com

Breast Reduction Surgery and Gynecomastia Surgery – Aetna

Number:0017

Policy

Reduction Mammoplasty:

Aetna considers breast reduction surgerycosmetic unless breast hypertrophy is causing significant pain, paresthesias, or ulceration (see selection criteria below). Reduction mammoplasty for asymptomatic members is considered cosmetic.

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 (I, II, or III) is met:

Macromastia: all of the following criteria must be met:

Member has persistent symptoms in at least2 of the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year:

and

All of the following criteria are met:

and

Women40 years of age or older are required to have a mammogram that was negative for cancer performed within the year prior to the date of the planned reduction mammoplasty;

and

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:

Table: Weight of breast tissue removed, per breast, as a function of body surface area

To calculate body surface area (BSA) see: https://qxmd.com/calculate/calculator_28/bmi-and-bsa-mosteller.

OR

BSA (m2 ) = ([height (in) x weight (lb)]/3131) ( denotes square root)

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.

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. 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.

Aetna considers liposuction-only reduction mammaplasty experimental and investigational because of insufficient evidence of its effectiveness.

Gigantomastia of Pregnancy:

The member has gigantomastia of pregnancy accompanied by any of the following complications, and delivery is not imminent:

Asymmetry:

For medical necessity criteria for surgery to correct breast asymmetry, seeCPB 0185 – Breast Reconstructive Surgery.

Gynecomastia Surgery:

Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia.

See alsoCPB 0031 – Cosmetic Surgery, andCPB 0185 – Breast Reconstructive Surgery.

Reduction Mammaplasty

Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. 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.

The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately.

In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast). 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.

Reduction mammaplasty is among the most commonly performed cosmetic procedures in the United States. Reduction mammaplasty 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.

Reduction mammaplasty has also been used for relief of pain in the back, neck and shoulders. Because reduction mammaplasty may be used for both medically necessary and cosmetic indications, Aetna has set forth above objective criteria to distinguish medically necessary reduction mammaplasty from cosmetic reduction mammaplasty.

Reduction mammaplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. Well-designed trials are especially important in assessing pain management interventions to isolate the contribution of the intervention from placebo effects, the effects of other concurrently administered pain management interventions, and the natural history of the medical condition. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects.

In the case of reduction mammaplasty for relief of back, neck and shoulder pain, Aetna has considered this procedure medically necessary in women with excessively large breasts because it seems logical, even in the absence of firm clinical trial evidence, that this excessive weight would contribute to back and shoulder pain, and that removal of this excessive breast tissue would provide substantial pain relief, reductions in disability, and improvements in function.

The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. 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).

Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. 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. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 60 g per breast, with a range of 502 g to 700 g of tissue removed per breast.

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. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. 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. 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).

Some individuals, however, have argued that reduction mammaplasty 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). They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). 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 mammaplasty.

It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain.

Criteria for reduction mammaplasty 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. 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). There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammaplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000).

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. 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. A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. 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). The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. 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. Several important points should be considered in evaluating these challenges to insurers’ criteria for breast reduction surgery. 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. 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. 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. Fourth, insurers have provided coverage for reduction mammaplasty 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. The authors of the BRAVO study reached several conclusions about reduction mammaplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). 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. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. 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. 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. 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. 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. The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammaplasty, or how they chose patients who underwent mammaplasty for inclusion in the study. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. 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. 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. Clinical outcomes were measured by operative subjects’ responses to a questionnaire about symptoms and quality of life. The authors stated that operative subjects were told that their responses to the questionnaire were not to be used for insurance and thus the subjects had no motivation to exaggerate symptoms prior to surgery in questionnaire responses; however, it is not clear whether operative subjects would be willing to submit responses to a questionnaire from the doctor that differed substantially from the history that they provided to the doctor during their preoperative evaluation. Although operative subjects were examined before and after surgery, there was no attempt to employ any blinded or objective measures of disability and function to verify these self-reports. Operative subjects who completed the study reported reductions in pain and improvements in quality of life; however, these improvements may be attributable to placebo effects, the natural history of back pain, other concurrent interventions, regression to the mean, improvements in cosmesis (for quality of life measures), or other confounding variables that may bias in interpretation of results. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammaplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammaplasty regarding physical symptoms and body image. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. The investigators found little difference between obese and non-obese women concerning patient’s reports of resolution of symptoms and improvement in body image. 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. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. It was also found that only 3 % of subjects reported that they had no aesthetic motivation for surgery. Behmand et al (2000) reported on the results of a questionnaire pre- and post-surgery in 69 subjects from a single practice who underwent reduction mammaplasty. Subjects were compared to age-matched norms from another study cohort. No data were provided on loss to follow-up. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammaplasty as subjects who were over-weight.

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. Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. In addition, reduction mammaplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 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.

For these reasons, there is insufficient evidence to support the use of reduction mammaplasty, 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.

The American Society of Plastic Surgeons’ evidence-based clinical practice guideline on reduction mammaplasty (ASPS, 2011) states thatin standard reduction mammaplasty procedures, evidence indicates that the use of drains is not beneficial. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon’s discretion.

The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists’2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. 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. Sabistons Textbook of Surgery (Burns & Blackwell, 2008)states that breast size should be stable for one year: There is no set lower age limit but, for the adolescent with breast hypertrophy, reduction is deferred until the breasts have stopped growing and are stable in size for at least 12 months before surgery.

Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammaplasty using the NSQIP) data sets. The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. 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%.The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P

Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. 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. A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). 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). 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. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes.

Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.They investigated effects of age on 30-day surgical outcomes for reduction mammaplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients.The study subjects were stratified into groups based on ages 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 mammaplasty. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. 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). The investigators found that comorbid conditions increased across obesity classifications (p

Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-social & QOL benefits of reduction mammoplasty. 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

Gynecomastia Surgery

Gynecomastia is a very common concern of male adolescence. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels.

Gynecomastia has been classified into2 types. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Type II gynecomastia is more generalized breast enlargement. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles.

Gynecomastia may be drug-induced. Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia.

Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia).

Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Work-up of gynecomastia may include the following (GP Notebook, 2003):

A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use.

A detailed physical examination, including testicular examination.

Liver and thyroid function tests.

Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS)

An ultrasound scan of testicular masses

Computed tomography scan of adrenal glands to identify adrenal lesions.

Treatment should be directed at correcting any underlying reversible causes. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Resolution of idiopathic gynecomastia may take several months to years. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. However, these medications should be reserved for those with no decrease in breast size after 2 years.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.

Many men with breast enlargement are found to have pseudo-gynecomastia. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. A physician-supervised diet and exercise plan may be indicated in obese patients.

Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. Mental health care professionals may be consulted to address psychological distress from gynecomastia.

In a review on Surgical treatment of primary gynecomastia in children and adolescents, Fischer et al (2014b) concluded that surgical correction of gynecomastia remains a purely elective intervention.

Autologous Platelet Gel During Breast Surgery

In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammaplasty to reduce post-operative wound drainage. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. The primary outcome was the difference in wound drainage over 24 hours. Secondary outcomes included subjective as well as objective assessments of pain and wound healing. 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. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammaplasty.

Appendix

Drugs associated with gynecomastia:

Others situations which can cause or lead to gynecomastia:

Adapted from General Practice Notebook.

American Society of Plastic Surgeons gynecomastia scale:

The above policy is based on the following references:

Brown DM, Young VL. Reduction mammoplasty for macromastia. Aesthet Plastic Surg. 1993;17(3):211-223.

Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291-303.

Gonzalez FG, Walton RL, Shafer B, et al. Reduction mammoplasty improves symptoms of macromastia. Plastic Reconstruct Surg. 1993;91(7):1270-1276.

Howrigan P. Reduction and augmentation mammoplasty. Obstet Gynecol Clin North Am. 1994;21(3):539-543.

American Society of Plastic and Reconstructive Surgery (ASPRS). Recommended criteria for insurance coverage of reduction mammoplasty. Socioeconomic Committee Position Paper. Arlington Heights, IL: ASPRS; 1987.

Seitchik MW. Reduction mammoplasty: Criteria for insurance coverage. Plastic Reconstruct Surg. 1995;95(6):1029-1032.

Miller AP, Zacher JB, Berggren RB, et al. Breast reduction for symptomatic macromastia. Can objective predictors for operative success be identified? Plastic Reconstruct Surg. 1995;95(1):77-83.

Bland KI, Copeland EM, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. Philadelphia, PA: W.B. Saunders Co.; 1991.

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. Scand J Plast Reconstr Hand Surg. 1990;24(1):61-67.

Schnur PL, Hoehn JG, Ilstrup DM, et al. Reduction mammoplasty: Cosmetic or reconstructive procedure? Ann Plastic Surg. 1991;27(3):232-237.

Schnur PL, Schnur DP, Petty PM, et al. Reduction mammaplasty: An outcome study. Plastic Reconstr Surg. 1997;100(4):875-883.

Raispis T, Zehring RD, Downey DL. Long-term functional results after reduction mammoplasty. Ann Plastic Surg. 1995;34(2):113-116.

Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Am Surg. 1995;61(11):1001-1005.

Flancbaum L, Choban PS. Surgical implications of obesity. Annu Rev Med. 1998;49:215-234.

Bertin ML, Crowe J, Gordon SM. Determinants of surgical site infection after breast surgery. Am J Infect Control. 1998;26(1):61-65.

Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. J Am Coll Surg. 1997;185(6):593-603.

Tang CL, Brown MH, Levine R, et al. Breast cancer found at the time of breast reduction. Plast Reconstr Surg. 1999;103(6):1682-1686.

Tang CL, Brown MH, Levine R, et al. A follow-up study of 105 women with breast cancer following reduction mammaplasty. Plast Reconstr Surg. 1999;103(6):1687-1690.

Brown MH, Weinberg M, Chong N, et al. A cohort study of breast cancer risk in breast reduction patients. Plast Reconstr Surg. 1999;103(6):1674-1681.

Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Aesthetic Plast Surg. 1996;20(5):391-397.

Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Plast Reconstr Surg. 1998;101(2):361-364.

Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Ann Plast Surg. 2000;45(6):575-580.

Mizgala CL, MacKenzie KM. Breast reduction outcome study. Ann Plast Surg. 2000;44(2):125-134.

Krieger LM, Lesavoy MA. Managed care’s methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Plast Reconstr Surg. 2001;107(5):1234-1240.

Sood R, Mount DL, Coleman JJ 3rd, et al. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. Plast Reconstr Surg. 2003;111(2):688-694.

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Breast Reduction Surgery and Gynecomastia Surgery – Aetna