# color: white; See Appendix for Table 1. Plast Reconstr Surg. and areola. Plast Reconstr Surg. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. 2018;24(6):1043-1045. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Gynecomastia is a very common concern of male adolescence. Bertin ML, Crowe J, Gordon SM. Can objective predictors for operative success be identified? } Brown DM, Young VL. Ann Plastic Surg. They concluded that higher resection weight, increased BMI, older age, and smoking are risk factors for complication and that patients should therefore be adequately counseled about losing weight and stopping smoking. 2012;130(4):785-789. border-width:0; .newText { There were only 2 studies of a total 25 patients that were considered as good in quality. In other patients, excess skin and nipple and areola relocation are necessary. Reduction mammaplasty: Defining medical necessity. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Kalliainen LK; ASPS Health Policy Committee. Surg Laparosc Endosc Percutan Tech. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Miller AP, Zacher JB, Berggren RB, et al. 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. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. The average age was 24.7 years (range of 18 to 47 years). The following procedures are considered experimental and investigational because there is insufficient evidence of itseffectiveness or itseffectiveness has not been established: Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. Oxford, UK: National Health Service (NHS); October 2008. Am Surg. 2021;74(11):3128-3140. 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. 1997;185(6):593-603. Ann Plast Surg. 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. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Plast Reconstr Surg. Aetna considers breast reconstructive surgery to correct 1993;17(3):211-223. 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. Annu Rev Med. J Plast Reconstr Aesthet Surg. 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. All RCTs that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. font-size: 18px; Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast. 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. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. 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 author identified the psychological domains affected by the disease and the effect of surgical treatment on these. Ann Plast Surg. } All the patients recovered well and were satisfied with the cosmetic outcomes. 2nd ed. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Ages ranged from 18 to 66 years. The investigators reported that subjects who were of normal weight were as likely to report benefit from reduction mammoplasty as subjects who were over-weight. All subjects were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100 %). Reduction mammoplasty: Cosmetic or reconstructive procedure? Plast Reconstr Surg. Reduction mammaplasty. 1995;95(6):1029-1032. He Q, Zheng L, Zhuang D, et al. High-risk lesions (atypical ductal hyperplasia [ADH], atypical lobular hyperplasia [ALH], and lobular carcinoma in situ [LCIS]) were revealed in 37 (11.7 %), and cancer in 6 (1.9 %) patients. } No new trials were identified for this first update. Blomqvist L, Eriksson A, Brandberg Y. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. } Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Sood R, Mount DL, Coleman JJ 3rd, et al. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Arlington Heights, IL: ASPRS; 1987. 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. 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. Macromastia: all . 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. The risks included infection, wound breakdown, scarring, and the need for re-operating. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. 2015;49(6):363-366. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Glatt BS, Sarwer DB, O'Hara DE, et al. Three review authors undertook independent screening of the search results. Administration of Benefits and Transition Responsibilities Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Ann Plast Surg. Coding Resolution of idiopathic gynecomastia may take several months to years. Arlington Heights, IL: ASPS; 2011. Nguyen JT, Wheatley MJ, Schnur PL, et al. Breast. list-style-type: lower-roman; Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. Plastic Reconstr Surg. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. display: block; Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass GP Notebook. Plast Reconstr Surg. 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. 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. ASPS Recommended Coverage Criteria for Third Party Payors. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Long-term functional results after reduction mammoplasty. Arch Dis Child. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Karamanos et al (2015) noted that although breast reduction mammoplasty accounts for more than 60,000 procedures annually, the literature remains sparse on outcomes. The Breast: Comprehensive Management of Benign and Malignant Diseases. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. However, it is unclear if there is any evidence to support this practice. The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. Data were prospectively gathered on complications as a part of randomized control trial (RCT) examining psycho-socialand quality of life(QOL) benefits of reduction mammoplasty. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. Plastic surgery for teenagers briefing paper. 2014b;48(5):334-339. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Priorities Forum Policy Statement. N Engl J Med. The study subjects were stratified into groups based on ages of <60 years and 60 years. Breast reduction surgery might also help improve self-image and the ability to take part in physical activities. Wound drainage after plastic and reconstructive surgery of the breast. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. 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. Am J Infect Control. cursor: pointer; 2002;33:208-217. Surgical treatment is indicated when medical treatments fail. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. 1999;103(6):1674-1681. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. No necrosis, systemic infection, or muscle paralysis was reported. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. Arlington Heights, IL: ASPS; March 9, 2002. 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. Pseudo-gynecomastia refers to excessive fat tissue or prominent pectoralis muscles. 2012;69(5):510-515. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. There were no restrictions on the basis of date or language of publication. Leclere FM, Spies M, Gohritz A, Vogt PM. 1999;103(6):1687-1690. Pain/discomfort/ulceration from bra straps cutting into shoulders; Skin breakdown (severe soft tissue infection, tissue necrosis, ulceration hemorrhage) from overlying breast tissue; There is a reasonable likelihood that the member's symptoms are primarily due to macromastia; Reduction mammoplasty (also spelled as 'mammaplasty') is likely to result in improvement of the chronic pain; Pain symptoms persist as documented by the physician despite at least a 3-month trial of therapeutic measures such as: Analgesic/non-steroidal anti-inflammatory drugs (NSAIDs) interventions and/or muscle relaxants, Dermatologic therapy of ulcers, necrosis and refractory infection, Physical therapy/exercises/posturing maneuvers, Supportive devices (e.g., proper bra support, wide bra straps), Chiropractic care or osteopathic manipulative treatment. 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. Aetna considers breast reduction surgery medically necessary for non-cosmetic indications for women aged 18 or older or for whom growth is complete (i.e., breast size stable over one year) when any of the following criteria (A, B, or C) is met: Macromastia: all of the following criteria must be met: 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. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. 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. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Plast Reconstr Surg. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. 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. Burdette TE, Kerrigan CL, Homa KA. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. .headerBar { Laituri CA, Garey CL, Ostlie DJ, et al. In a systematic review, these investigators examined the role of radiotherapy in this context. Breast and aesthetic surgery. The investigators found that comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). li.bullet { Statistical analysis was performed with student t-test and chi-square test. American Society of Plastic Surgeons (ASPS). Fagerlund A, Cormio L, Palangi L, et al. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. 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. 2010;125(5):1301-1308. 2000;106(2):280-288. 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). } Tang CL, Brown MH, Levine R, et al. of . Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? 2004;113(1):436-437. 2010;45(3):650-654. Reduction mammoplasty improves symptoms of macromastia. Type II gynecomastia is more generalized breast enlargement. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. 1998;101(2):361-364. Qu S, Zhang W, Li S, et al. Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Reduction mammoplasty: Criteria for insurance coverage. Reduction mammoplasty for macromastia. 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. Philadelphia, PA: W.B. } A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. 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. 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. 2018;7(Suppl 1):S70-S76. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. For many patients the psychological impact of the disease is substantial. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. 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 mammoplasty. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. 1. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). skin should not be excised horizontally below the inframammary fold. of the following criteria must be met: They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. .fixedHeaderWrap { 1997;100(4):875-883. cursor: pointer; Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Reduction mammaplasty: The need for prospective randomized studies. 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). @media print { The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Refer to the member's specific plan document for applicable coverage. Prepubertal gynecomastia linked to lavender and tea tree oils. This investigators stated that these studies should include data from older individuals affected by gynecomastia and utilize valid tools of psychological measurement in order to better quantify the effect; elderly patients affected by the disease have been over-looked in the current research; more data on this subject could improve the pre-operative evaluation of these patients and help identify the patients who will benefit from treatment. Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. Fischer JP, Cleveland EC, Shang EK, et al. Yao Y, Yang Y, Liu J, et al. A population-level analysis of bilateral breast reduction: does age affect early complications? background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Schnur PL, Schnur DP, Petty PM, et al. color: white; 2007;356(5):479-485. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Setala L, Papp A, Joukainen S, et al. To get insurance coverage, you'll probably need . For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. OL OL OL OL LI { Ann Plast Surg. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. 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. display: none; The majority (87.7 %) of cases presented with accompanying mastalgia. 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. Surgery. 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). Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. #backTop { A total of 211 responding surgeons were analyzed, including 80.1 % (171/211) plastic surgeons and 18.9 % (40/211) breast surgeons. Women's Health and Cancer Rights Act of 1998. Patient demographics, surgical technique, and outcomes were analyzed. margin-bottom: 38px; 2018;89(6):408-412. A detailed drug history, including list of medications, an assessment of indirect or environmental exposure to estrogenic compounds, and recreational drug use. Kerrigan CL, Collins ED, Kneeland TS, et al. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. 2021;147(5):1072-1083. Computed tomography scan of adrenal glands to identify adrenal lesions. (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. 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. Plast Reconstr Surg. Aesthetic Plast Surg. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. The health burden of breast hypertrophy. 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. Aetna considers breast reduction surgery medically necessary for non-cosmetic indications for women aged 18 or older or for whom growth is complete (i.e., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. width: 100%; OL OL LI { Breast cancer found at the time of breast reduction. Burns JL, Blackwell SJ. Plast Reconstr Surg. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. 2006;118(4):840-848. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Reduction mammaplasty: An outcome study. } Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Several of the included studies reported improvement in QOL and several psychological domains after surgical treatment for gynecomastia. Last Review01/04/2023. height:2px; The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Breast asymmetries: A brief review and our experience. } Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. The author concluded that the current level of evidence on this subject was very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. 2000;44(2):125-134. padding: 15px; top: 0px; 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 mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. 1995;95(1):77-83. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for bottom: 20px; 2014b;30(6):641-647. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Aesthet Surg J. 1995;61(11):1001-1005. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. Ann Plast Surg. /*margin-bottom: 43px;*/

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