Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. 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. Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). 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. 2010;125(5):1301-1308. Petty PM, Solomon M, Buchel EW, Tran NV. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Disproportionately large breasts can cause both physical and emotional . Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. display: block; 01/04/2023 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. } (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. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. 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: Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. Oxford, UK: National Health Service (NHS); October 2008. 2004;113(1):436-437. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. padding: 10px; The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. There were no restrictions on the basis of date or language of publication. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. The authors concluded that the limited evidence available showed no significant benefit of using post-operative wound drains in reduction mammoplasty, although LOS may be shorter when drains are not used. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). Surgical treatment of primary gynecomastia in children and adolescents. 1995;95(6):1029-1032. Reduction mammoplasty: Cosmetic or reconstructive procedure? #backTop:hover { 2015;10(8):e0136094. All patients underwent routine investigations to exclude secondary causes of gynecomastia. The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. cursor: pointer; Breast J. Follow-up ranged from 2 months to 3 years. Surgical implications of obesity. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. Breast reduction outcome study. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Wound drainage after plastic and reconstructive surgery of the breast. 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. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. It can cause discomfort and concern, resulting in patients seeking diagnosis and treatment. The study subjects were stratified into groups based on ages of <60 years and 60 years. Plast Reconstr Surg. Plast Reconstr Surg. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. 1999;103(6):1682-1686. American Society of Plastic Surgeons (ASPS). 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. This may lead to additional scarring and additional operating time. 1995;95(1):77-83. Sugrue CM, McInerney N, Joyce CW, et al. PLoS One. Br J Plast Surg. Radiotherapy was shown to significantly reduce the incidence to a median of 23 %, with all 6 RCTs assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Cochrane Database Syst Rev. American Society of Plastic Surgeons (ASPS). .strikeThrough { 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 associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. 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. In a systematic review, these investigators examined the role of radiotherapy in this context. Sugrue and associates (2015) evaluated the current practice patterns of drains usage by plastic and reconstructive and breast surgeons in United kingdom (UK) and Ireland performing bilateral breast reduction (BBR). 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. Fagerlund A, Lewin R, Rufolo G, et al. Araco A, Gravante G, Araco F, et al. 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. 2008;32(1):38-44. Risk factors for complications following breast reduction: Results from a randomized control trial. 2002;109(5):1556-1566. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. The safety, efficacy, complications, and patient satisfactions were recorded during post-operative follow-up periods. 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. Most cases of type I gynecomastia are unilateral, and 20% of cases are bilateral. Please check your insurance policy to see whether breast reduction is a covered procedure. A total of 81 patients were included in this study. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Sood R, Mount DL, Coleman JJ 3rd, et al. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. text-decoration: line-through; 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). Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. 2011;128(4):243e-249e. With approval from the authors institutional ethics committee and written informed consent, a total of 22 patients with 33 abnormally hyperplastic breasts were enrolled at the First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. Horm Res Paediatr. Blomqvist L, Eriksson A, Brandberg Y. Kalliainen LK; ASPS Health Policy Committee. 1997;100(4):875-883. These investigators stated that in an era of evidence-based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice. 2001;76(5):503-510. 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. Arlington Heights, IL: ASPS; May 2011. border: none; 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. All the patients recovered well and were satisfied with the cosmetic outcomes. list-style-type: upper-alpha; Major complications (1.6 %) included unilateral hematoma and localized infection. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. outline: none; 1993;91(7):1270-1276. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. 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. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Breast Concerns of Adolescents. Miller AP, Zacher JB, Berggren RB, et al. Handschin AE, Bietry D, Hsler R, et al. 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). 1993;17(3):211-223. Aesthet Plastic Surg. background: #5e9732; 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. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Reduction mammoplasty for macromastia. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Mayo Clin Proc. These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). 2nd ed. J Plast Reconstr Aesthet Surg. Abnormal histopathological findings were more frequent in patients with reduction mammoplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). A non-standardized survey showed a very high satisfaction index. The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. Gland Surg. --> 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. 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%. Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. Refer to the member's specific plan document for applicable coverage. OL OL OL OL LI { padding-right: 18px; Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. 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). Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. For many patients the psychological impact of the disease is substantial. Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. N Engl J Med. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Recommended criteria for insurance coverage of reduction mammoplasty. }. Endocrinol Metab Clin North Am. background-position: right 65%; Devalia HL, Layer GT. ul.ur li{ Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. 2011;21(5):431-434. Henley DV, Lipson N, Korach KS, Bloch CA. 2018;7(Suppl 1):S70-S76. Managed care's methods for determining coverage of plastic surgery procedures: The example of reduction mammaplasty. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. } Ages ranged from 18 to 66 years. Statistical analysis was performed with student t-test and chi-square test. Links to various non-Aetna sites are provided for your convenience only. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Burdette TE, Kerrigan CL, Homa KA. 2008;53(3):255-261. } The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. list-style-type: lower-roman; 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. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. 2015;(10):CD007258. 1995;61(11):1001-1005. cursor: pointer; The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. 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. of . Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. 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. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. 2007;356(5):479-485. 2006;118(4):840-848. 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. The mean volume of tissue resected was 250 g (range of 22 to 758 g) from the right breast and 244 g (range of 15 to 705 g) from the left breast. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Surg Laparosc Endosc Percutan Tech. J Plast Reconstr Aesthet Surg. margin-bottom: 38px; The operation had a mean duration of 73.5 mins per side, ranging from 40 to 102 mins. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. 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? Arch Dis Child. There were only 2 studies of a total 25 patients that were considered as good in quality. No data were provided on loss to follow-up. In the case of reduction mammoplasty 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. Leclere FM, Spies M, Gohritz A, Vogt PM. Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. 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. Study appraisal was carried out using MINORS to evaluate the methodological quality of the paper. Plast Reconstr Surg. 1995;34(2):113-116. Arlington Heights, IL: ASPS; March 9, 2002. For pain interventions, evidence of effectiveness is necessary from well controlled, randomized prospective clinical trials assessing effects on pain, disability, and function. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. 2012;69(5):510-515. 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. The average amount of tissue removed from an average weight woman (within the 70 to 74.9 kg weight band) in this study was 600 g per breast, with a range of 502 g to 700 g of tissue removed per breast. Other just require 500 grams no matter what your height and weight. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. padding: 15px; 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). list-style-type : square !important; This will be computed based on your body area. text-decoration: underline; Nguyen JT, Wheatley MJ, Schnur PL, et al. } of the following criteria must be met: 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. skin should not be excised horizontally below the inframammary fold. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. The authors concluded that high digit ratio in men with gynecomastia may tend to be a marker of over-expression of ER and PR. A systematic search of the published literature was performed. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne 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. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. color: red Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years). Risk of bias was assessed independently by 2review authors. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Plastic Reconstruct Surg. } right: 30px; In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Am J Infect Control. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Breast J. } 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). Fischer S, Hirsch T, Hirche C, et al. 2006;9(2):109-114. 2006;30(3):309-319. Reduction mammaplasty: An outcome study. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. 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 mammoplasty. 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 mammoplasty to reduce post-operative wound drainage. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. } Mental health care professionals may be consulted to address psychological distress from gynecomastia. /* aetna.com standards styles for templates */ Setala L, Papp A, Joukainen S, et al. Raispis T, Zehring RD, Downey DL. A total of 244 out of 1,628 patients with the average age of 23.13 years. 1999;103(6):1674-1681. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. 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). 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. A cohort study of breast cancer risk in breast reduction patients. Treating providers are solely responsible for medical advice and treatment of members. } And if you are in Canada the surgeon decides. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Prepubertal gynecomastia linked to lavender and tea tree oils. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the margin-top: 38px; 2000;106(2):280-288. Fagerlund A, Cormio L, Palangi L, et al. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . hr.separator { Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . border-width:0; .strikeThrough { 2018;89(6):408-412. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Breast cancer found at the time of breast reduction. J Plast Surg Hand Surg. 1998;49:215-234. This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. Ann Plast Surg. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Plast Reconstr Surg. 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. 2017;35:157-161. 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. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review.
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