Reduction Mammaplasty (Non-Cancerous) (Reduction Mammoplasty)
Reduction mammoplasty is a surgical procedure designed to remove a variable proportion of breast tissue. Macromastia, or gigantomastia, is a condition that describes breast hyperplasia or hypertrophy.
Macromastia may result in clinical symptoms such as shoulder, neck, or back pain, or recurrent intertrigo in the mammary folds. In addition, macromastia may be associated with psychosocial or emotional disturbances related to the large breast size. The available evidence from randomized controlled and prospective studies indicates that reduction mammoplasty is effective at decreasing breast-related symptoms such as pain and discomfort. There is also evidence that functional limitations related to breast hypertrophy are improved following reduction mammoplasty. Therefore, the available evidence for reduction mammoplasty is sufficient to demonstrate improvements in net health outcome.
Reduction mammoplasty for the treatment of macromastia is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Reduction mammoplasty for the treatment of other conditions/diseases is considered cosmetic.
Reduction mammaplasty is considered medically appropriate if ALL of the following are met:
Symptoms of individual breast hypertrophy as indicated by 2 or more of the following:
Upper extremity peripheral neuropathy
Postural change with a tendency toward dorsal kyphosis
Problems associated with breast weight and brassiere support, such as clavicular bra strap grooves
Hygiene problems, such as intertrigo or exacerbation of acne and hidradenitis suppurativa
Limitations of normal activity, such as inability to participate in exercise and sports
Difficulty sleeping or breathing due to weight of the breasts
Failure to relieve symptoms with nonsurgical treatment that includes a six week history of ANY ONE of the following:
Appropriate support bra
Nonsteroidal anti-inflammatory agents/muscle relaxants
BMI of 35 or less
Estimated tissue reduction of minimum 400 grams per breast
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American Society of Plastic Surgeons. (May, 2011). Evidence-based clinical practice guideline: reduction mammoplasty. Retrieved March 28, 2017 from www.plasticsurgery.org
BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2017). Reduction mammoplasty for breast-related symptoms (7.01.21). Retrieved March 28, 2017 from BlueWeb. (23 articles and/or guidelines reviewed)
British Association of Plastic Reconstructive and Aesthetic Surgeons. (May, 2014). Commissioning guide: breast reduction surgery. Retrieved May 18, 2015 from http://www.rcseng.ac.uk.
Cahaba Government Benefit Admonistrators (2015, October). Local Coverage Determination LCD for surgery: reduction mammaplasty (L35554). Retrieved June 7, 2016 from https://www.cms.gov.
Cerrato, F., Webb, M., Rosen, H., Nuzzi, L., McCarty, E., DiVasta, A., et. al., (2012, August) The impact of macromastia on adolescents: a cross-sectional study. Pediatrics. Vol. 130, No. 2. (Level 3 evidence)
Chun, Y.S., Schartz, M.A., Gu, X., Lipsitz, S.R., & Carty, M.J. (2012). Body mass index as a predictor of postoperative complications in reduction mammaplasty. Plastic and Reconstructive Surgery, 129 (2), 228-233. Abstract retrieved July 24, 2015 from PubMed database.
Desouki, M. (2015, November) Reduction mammoplasty is beneficial in women with and without history of breast Cancer. Women’s Health. (2015) 11(4), 419–422. (Level 3 evidence)
Gonzalez, M.A., Glickman, L.T., Aladegbami, B., & Simpson, R.L. (2012). Quality of life after breast reduction surgery: a 10-year retrospective analysis using the breast Q questionnaire: does breast size matter? Annals of Plastic Surgery, 69 (4), 361-363. Abstract retrieved May 20, 2015 from PubMed database.
Gust, M.J., Smetona, J.T., Persing, J.S., Hanwright, P.J., Fine, N.A., & Kim, J.Y. (2013). The impact of body mass index on reduction mammoplasty: a multicenter analysis of 2492 patients. Aesthetic Surgery Journal, 33 (8), 1140-1147. Abstract retrieved May 20, 2015 from PubMed database.
Manahan, M.A., Buretta, K.J., Chang, D., Mithani, S.K., Mallalieu, J., & Shermak, M.A. (2015). An outcomes analysis of 2142 breast reduction procedures. Annals of Plastic Surgery, 74 (3), 289-292. Abstract retrieved June 3, 2015 from PubMed database.
Nelson, J.A., Fischer, J.P., Chung, C.U., West, A., Tuggle, C.T., et al. (2014). Obesity and early complications following reduction mammaplasty: an analysis of 4545 patients from the 2005-2011 NSQIP datasets. Journal of Plastic Surgery and Hand Surgery, 48 (5), 334-339. Abstract retrieved July 24, 2015 from PubMed database.
Singh, K.A. & Losken, A. (2012). Additional benefits of reduction mammoplasty: a systemic review of the literature. Plastic and Reconstructive Surgery, 129 (3), 562-570. Abstract retrieved June 3, 2015 from PubMed database.
Strong, B. and Hall-Findlay, E. (2014, April) How does volume of resection relate to symptom relief for reduction mammaplasty patients? Annals of Plastic Surgery. Epub ahead of print. Retrieved June 7, 2016 from PubMed database.
ORIGINAL EFFECTIVE DATE: 1/1/1997
MOST RECENT REVIEW DATE: 5/11/2017
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