aetna breast reduction requirementsdefective speedometer wisconsin

Nguyen JT, Wheatley MJ, Schnur PL, et al. OL OL OL LI { 2015;75(4):370-375. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Based on CPB criteria and the information we have, we're denying coverage for breast reduction surgery. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. padding-bottom: 4px; background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Current concepts in gynaecomastia. Treatment of adolescent gynecomastia. A detailed physical examination, including testicular examination. They evaluated the use of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. 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. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 %)]. Cochrane Database Syst Rev. Blomqvist L, Eriksson A, Brandberg Y. Plast Reconstr Surg. 2007;36(2):497-519. 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. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Causes may include testosterone-estrogen imbalance, increased prolactin levels, or abnormal serum binding protein levels. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. .headerBar { The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. 2006;118(4):840-848. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. Philadelphia, PA: W.B. Reduction mammaplasty: An outcome study. 2015;10(8):e0136094. Scand J Plast Reconstr Hand Surg. Aetna considers breast reconstructive surgery to correct Risk factors for complications following breast reduction: Results from a randomized control trial. 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: Aesthetic Plast Surg. A population-level analysis of bilateral breast reduction: does age affect early complications? They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. J Plast Reconstr Aesthet Surg. The article by Blomqvist et al (2000) is to another questionnaire study about health status and quality of life before and after surgery. Ann Plastic Surg. 0017 - Breast Reduction Surgery and Gynecomastia Surgery, are met. color: red!important; Policy Statement 6d: Aesthetic surgery procedures. Karamanos E, Wei B, Siddiqui A, Rubinfeld I. Administration of Benefits and Transition Responsibilities The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. 1995;95(6):1029-1032. Follow-up ranged from 2 months to 3 years. All patients underwent routine investigations to exclude secondary causes of gynecomastia. The authors concluded that breast re-reduction can be performed safely and predictably, even when the previous technique is not known; and 4 key principles were developed: Language services can be provided by calling the number on your member ID card. 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. background-color: #cc0066; 18th ed. In a majority of boys with pubertal gynecomastia, the condition resolves within 18 months. All studies on the subject were evaluated for inclusion and 6 studies were included in the review. 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. Refer to the member's specific plan document for applicable coverage. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. It's important to note that CPT 19324 - mammaplasty, augmentation without pros-thetic implant - has been deleted. ASPS Recommended Coverage Criteria for Third Party Payors. Breast reconstruction/breast enlargement Breast reduction/mammoplasty Excision of excessive skin due to weight loss Gastroplasty/gastric bypass Other just require 500 grams no matter what your height and weight. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Lonie S, Sachs R, Shen A, et al. 1999;103(6):1674-1681. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: A review. 2002;109(5):1556-1566. Variations in pattern of pubertal changes in girls. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Plastic Reconstr Surg. Level of Evidence = IV. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses. Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. A total of 81 patients were included in this study. American Society of Plastic and Reconstructive Surgery (ASPRS). li.bullet { World J Surg. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Breast reduction outcome study. 2014a;34(3):409-416. 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. 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. 40 . 2015;(10):CD007258. } Reduction mammaplasty provides long-term improvement in health status and quality of life. 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. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. 2011;128(4):243e-249e. Policy. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Hermans, BJ, Boeckx, WD, De Lorenzi, F, Vand der Hulst, RR. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits. Gynecomastia: A systematic review. .newText { In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. Ann Plastic Surg. color:#eee; Major complications (1.6 %) included unilateral hematoma and localized infection. The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. 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. } Aesthetic Plast Surg. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. Arlington Heights, IL: ASPRS; 1987. The authors of the BRAVO study reached several conclusions about reduction mammoplasty, 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). /* aetna.com standards styles for templates */ Philadelphia, PA: WB Saunders Company; 2008; Ch 73. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. Reduction mammoplasty: Cosmetic or reconstructive procedure? Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Horm Res Paediatr. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. 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. Arlington Heights, IL: ASPS; 2011. 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. Pediatr Surg Int. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. 2015;49(6):363-366. OL OL OL OL LI { American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. 2000;44(2):125-134. 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. Analysis was on an intention-to-treat basis. 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. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. All the patients recovered well and were satisfied with the cosmetic outcomes. border-radius: 4px; .strikeThrough { In these cases, breast reduction for men may take 2 to 3 hours. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. 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. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. 1998;41(3):240-245. Ann Plast Surg. No necrosis, systemic infection, or muscle paralysis was reported. You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Plastic Reconstruct Surg. Burdette TE, Kerrigan CL, Homa KA. For individuals who received radiation treatment to the chest . This will be computed based on your body area. Often times, insurance company will dictate how much breast tissue to be removed. 2 . Statistical analysis was performed with student t-test and chi-square test. Tang CL, Brown MH, Levine R, et al. 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. These preliminary findings need to be validated by well-designed studies. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). Sugrue CM, McInerney N, Joyce CW, et al. 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. z-index: 99; 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. Marshall WA, Tanner JM. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. OL LI { Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . Merkkola-von Schantz PA, Jahkola TA, Krogerus LA, Kauhanen SMC. Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. 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). } of the following criteria must be met: Macromastia: all . 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. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. The authors concluded that even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilized. } 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. 1999;103(6):1682-1686. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. J Am Coll Surg. In other patients, excess skin and nipple and areola relocation are necessary. Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. 2014a;34(1):66-73. Aesthet Surg J. Setala L, Papp A, Joukainen S, et al. Breast. 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. Healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oilor tea tree oil. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Ann Plast Surg. Plast Reconstr Surg. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Reduction mammoplasty for asymptomatic members is considered cosmetic. Kerrigan CL, Collins ED, Striplin D, et al. Ann Chir Plast Esthet. 1997;185(6):593-603. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. 2008;53(3):255-261. Saunders Co.; 1991. American Society of Plastic Surgeons (ASPS). Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. 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. display: none; Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Priorities Forum Policy Statement. 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). Devalia HL, Layer GT. See Appendix for Table 1. Ann Plast Surg. However, it is unclear if there is any evidence to support this practice. Brown MH, Weinberg M, Chong N, et al. Aetna and the City shall each abide by all applicable laws, regulations and government requirements regarding the confidentiality and the safeguarding of individually identifiable health and other personal information, including the privacy and security requirements of HIPAA. 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. The mean age was 42.8 years (SD 19.5 years). Mizgala CL, MacKenzie KM. Schnur PL, Hoehn JG, Ilstrup DM, et al. Reduction mammoplasty is among the most commonly performed cosmetic procedures in the United States. 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. } Handschin AE, Bietry D, Hsler R, et al. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. 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. A physician-supervised diet and exercise plan may be indicated in obese patients. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. Raispis T, Zehring RD, Downey DL. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. J Plast Reconstr Aesthet Surg. 2008;121(4):1092-1100. 2001;107(5):1234-1240. 1995;34(2):113-116. Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest. For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. Covered items may include: A manual or standard electric pump (non-hospital grade) while you are pregnant or for the duration of breastfeeding. 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. The average age of the studied individuals was 25.7 years (SD = 7.8); ER and PR expression was detected in breasts, and digit ratios were calculated in patients with idiopathic gynecomastia. Obesity and complications in breast reduction surgery: Are restrictions justified? Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Endocrinol Metab Clin North Am. right: 30px; text-decoration: underline; Evidence-based clinical practice guideline: Reduction mammaplasty. 1995;95(1):77-83. The American Society of Plastic Surgeons' evidence-based clinical practice guideline on reduction mammoplasty (ASPS, 2011) states thatin standard reduction mammoplasty procedures, evidence indicates that the use of drains is not beneficial. 2010;125(5):1301-1308. However, if liposuction is used as an adjunctive technique, the decision to use drains should be left to the surgeon's discretion. Am Surg. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Plast Reconstr Surg. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. 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. 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. 2020 Sep 4 [Online ahead of print]. Gland Surg. 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. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. Reduction mammaplasty. These investigators analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammoplasty specimens of women with previous breast cancer. Measuring health state preferences in women with breast hypertrophy. margin-bottom: 38px; In the case of breast reduction, however, for insurance purposes, it . 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. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 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. Of the responding surgeons, 71.6 % (151/211) routinely inserted post-operative drains, for a mean of 1.32 days. 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. Reduction mammaplasty: The need for prospective randomized studies. 1994;21(3):539-543. Gynecomastia. The average age was 24.7 years (range of 18 to 47 years). Mayo Clin Proc. The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. Gynecomastia in patients with prostate cancer: Update on treatment options. Other referencesto smaller studies published prior to the BRAVO study have been cited,examining symptoms before and after reduction mammoplasty; each of these studies suffer from limitations similar to those identified with the BRAVO study. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. No author listed. outline: none; Determinants of surgical site infection after breast surgery. 2009;19(3):e85-e90. Subjects responses were compared to an age-matched comparison group of women, although no further details about how this comparison group were provided. A total of 90 patients underwent breast re-reduction surgery. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Narula HS, Carlson HE. 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). This Clinical Policy Bulletin may be updated and therefore is subject to change. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Howrigan P. Reduction and augmentation mammoplasty. Coding The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Arlington Heights, IL: ASPS; May 2011. Ann Plast Surg. Gynecomastia may be drug-induced. Bland KI, Copeland EM, eds. 2019;8(4):431-440. Guidelines for Adolescent Health Care. Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. 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. 2000;106(5):991-997. 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. 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). Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). /*margin-bottom: 43px;*/ Leclere FM, Spies M, Gohritz A, Vogt PM. 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. American Society of Plastic Surgeons (ASPS). .newText { skin should not be excised horizontally below the inframammary fold. 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. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. padding: 10px;

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