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. background-color: #663399; The authors concluded that vacuum-assisted, minimally invasive mastectomy was a feasible approach for the treatment of gynecomastia with acceptable complications. Reduction mammoplasty for macromastia. Oxford, UK: National Health Service (NHS); October 2008. 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). 2014a;34(3):409-416. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? 2015;75(4):383-387. No author listed. American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care. The risks included infection, wound breakdown, scarring, and the need for re-operating. Although the BRAVO study is described as a controlled study, the "control" group is obtained, not from the same cohort, but from a separate cohort of individuals recruited from newspaper advertisements and solicitations at meetings for inclusion in a study of the population burden of breast hypertrophy; 75 % of this control group were obtained from2 centers, but the characteristics of those2 centers were not described. If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. } 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). Plast Reconstr Surg. Plast Reconstr Surg. 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. Breast and aesthetic surgery. Srinivasaiah N, Iwuchukwu OC, Stanley PR, et al. Merkkola-von Schantz and colleagues (2017) stated that contralateral reduction mammoplasty is regularly included in the treatment of breast cancer patients. Gonzalez FG, Walton RL, Shafer B, et al. 2010;125(5):1301-1308. 2005;58(3):286-289. Surgery. Breast hypertrophy. 18th ed. Most UnitedHealthcare plans have a specific exclusion for breast reduction surgery except as required by the . See Appendix for Table 1. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. padding-right: 18px; PLoS One. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Chadbourne EB, Zhang S, Gordon MJ, et al. 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. li.bullet { For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). 1995;34(2):113-116. cursor: pointer; 1998;41(3):240-245. 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. Determinants of surgical site infection after breast surgery. Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. 2021;74(11):3128-3140. Approximately 25 % of the 49 subjects included in this study did not return the post-operative questionnaire. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. The condition not only must be unresponsive to dermatological treatments (e.g., antibiotics or antifungal therapy) and conservative measures (e.g., good skin hygiene, adequate nutrition) for a period of 6 months or longer, but also must satisfy criteria stated insection I above. The study subjects were stratified into groups based on ages of <60 years and 60 years. 2001;107(5):1234-1240. Schnur PL, Hoehn JG, Ilstrup DM, et al. Gynecomastia: Evolving paradigm of management and comparison of techniques. 2008;32(1):38-44. Bertin ML, Crowe J, Gordon SM. Guidelines for Adolescent Health Care. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. 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). Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. 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). 2005;55(3):227-231. This may lead to additional scarring and additional operating time. 2019;166(5):934-939. 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). Administration of Benefits and Transition Responsibilities 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. Women's Health and Cancer Rights Act of 1998. 1995;95(6):1029-1032. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. 2014b;48(5):334-339. The majority (87.7 %) of cases presented with accompanying mastalgia. 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. 2010;45(3):650-654. You first need to demonstrate that the procedure is "medically necessary and therefore reconstructive rather than cosmetic," says board-certified New York City plastic surgeon Dr. Umbareen Mahmood. 2019;8(4):431-440. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. Patients undergoing surgery for gynecomastia should know that their scars may be visible when they are shirtless. Aesthetic Plast Surg. 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. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. 2015;49(6):311-318. } These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. 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. 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. If an insufficient amount of breast tissue is removed, the surgery is less likely to be successful in relieving pain and any related symptoms from excessive breast weight (e.g., excoriations, rash). Also, there was no correlation between PR expression and 2D: 4D. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. These preliminary findings need to be validated by well-designed studies. Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. The investigators found little difference between obese and non-obese women concerning patient's reports of resolution of symptoms and improvement in body image. Br J Plast Surg. There were only 2 studies of a total 25 patients that were considered as good in quality. 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. height:2px; .newText { @media print { 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. Plast Reconstr Surg. Plast Reconstr Surg. 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. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. border: none; Two review authors undertook independent data extraction of study characteristics, methodological quality and outcomes (e.g., infection, other wound complications, pain, and length of hospital stay [LOS]). 1998;26(1):61-65. Reduction mammaplasty: An outcome study. Gynecomastia. Am J Infect Control. background: #5e9732; Reduction mammaplasty: Defining medical necessity. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. J Laparoendosc Adv Surg Tech A. Complication rates were inconsistent throughout the studies, ranging from 0.06 % to 26.67 %. Fischer S, Hirsch T, Hirche C, et al. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. 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 primary outcome was the difference in wound drainage over 24 hours. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. 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. Emiroglu M, Salimoglu S, Karaali C, et al. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Policy Statement 6d: Aesthetic surgery procedures. Computed tomography scan of adrenal glands to identify adrenal lesions. This Clinical Policy Bulletin may be updated and therefore is subject to change. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. Gland Surg. 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. Among these domains were: vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Other just require 500 grams no matter what your height and weight. } Aetna considers associated nipple and areolar reconstruction and tattooing of the nipple area medically necessary. Drugs whose mechanism of action is unknown: Others situations which can cause or lead to gynecomastia: The above policy is based on the following references: Last Review Reduction mammoplasty: Criteria for insurance coverage. Burdette TE, Kerrigan CL, Homa KA. font-size: 18px; A non-standardized survey showed a very high satisfaction index. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Plastic Reconstr Surg. background-color: #cc0066; 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%. J Plast Surg Hand Surg. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. A systematic search of the published literature was performed. list-style-type: decimal; 2006;118(4):840-848. If gynecomastia is idiopathic, reassurance of the common, transient and benign nature of the condition should be given. Gynecomastia is a very common concern of male adolescence. 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. 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? Seitchik MW. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). 2021 Aug 11 [Online ahead of print]. background-color:#eee; Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. The average amount of breast tissue removed ranged from 430 g per breast to 1.6 kg per breast, with increased body weight associated with an increased amount of breast tissue to be removed. Tang CL, Brown MH, Levine R, et al. Collis N, McGuiness CM, Batchelor AG. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. A follow-up study of 105 women with breast cancer following reduction mammaplasty. Arlington Heights, IL: ASPS; May 2011. 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. 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. text-decoration: line-through; 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. Treatment of adolescent gynecomastia. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. This may justify an early use of tamoxifen in men with gynecomastia and a high digit ratio. Ann Plast Surg. Fagerlund A, Lewin R, Rufolo G, et al. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. A study reporting on a survey of health insurer policies on breast reduction surgery (Nguyen et al, 2004) found that no insurer medical policies could be supported by the medical literature. Surgeon. 2007;356(5):479-485. Chemical peels (chemical exfoliation): Considered medically necessary when criteria in CPB 0251 - Dermabrasion, Chemical Peels, and Acne 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. Analysis was on an intention-to-treat basis. bottom: 20px; The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. 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 Answer: Aetna Insurance Breast reduction may or may not be covered depending on your insurance carrier and your breast size. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. Subgroup analysis further stratified the younger cohort into those <50 years and 50-60 years of age. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. /* aetna.com standards styles for templates */ hr.separator { } Lonie S, Sachs R, Shen A, et al. } Reduction mammaplasty: The need for prospective randomized studies. Asian J Surg. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. Major complications (1.6 %) included unilateral hematoma and localized infection. Surgical implications of obesity. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. #backTop:hover { Little is known about the effect of surgical treatment on the psychological aspects of the disease. However, the measuring method of satisfaction rate varied, resulting in difficulties to interpret the results. The surgeon must also certify that a certain weight of breast tissue (based on Aetna's table) will be removed in every breast, and not entirely fatty tissue. Mayo Clin Proc. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. 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. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). These individuals cite evidence from observational studies to support this position (e.g., Chadbourne et al, 2001; Kerrigan et al, 2001). Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. 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. margin-top: 38px; World J Surg. Here's what Aetna said in the denial: "We used the Clinical Policy Bulletin (CPB): Breast Reduction Surgery. Managed care's methods for determining coverage of plastic surgery procedures: The example of 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. Plastic surgery for teenagers briefing paper. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Brown DM, Young VL. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . list-style-type: lower-roman; Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. Breast reduction for symptomatic macromastia. 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. } 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. top: 0px; They stated that in the light of these findings, contralateral reduction mammoplasty with histopathological evaluation in breast cancer patients offered a sophisticated tool to catch those patients whose contralateral breast needs increased attention. Krieger LM, Lesavoy MA. 2004;113(1):436-437. 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. Current concepts in gynaecomastia. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. } The NSQIP recorded two complication types: major complications (deep infection and return to operating room) and any complication (all surgical complications). 2002;109(5):1556-1566. Ann Plast Surg. 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. .newText { Aesthetic Plast Surg. Scand J Plast Reconstr Hand Surg. # color: white; The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. American Society of Plastic Surgeons (ASPS). Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia. 1. Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). Breast asymmetries: A brief review and our experience. Arch Dis Child. Plast Reconstr Surg. 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. Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. color: white; Risk factors for complications following breast reduction: Results from a randomized control trial. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. } Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Marshall WA, Tanner JM. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Macromastia: all . The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Sixty to 70% of males develop a transient subareolar breast tissue during their adolescence (Tanner Stages II and III). 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. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. OL OL OL LI { Re-operation rate of liposuction-assisted surgery was between 0.6 % and 25 %. 2017;139(6):1313-1322. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. } Ann Plast Surg. ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). 2003;111(2):688-694. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. Breast Reduction Surgery and Gynecomastia Surgery - Medical Clinical Policy Bulletins | Aetna Page . 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. Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. J Plast Reconstr Aesthet Surg. Mizgala CL, MacKenzie KM. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. This will be computed based on your body area. Several important points should be considered in evaluating these challenges to insurers' criteria for breast reduction surgery. Subjects were compared to age-matched norms from another study cohort. Autorino R, Perdona S, D'Armiento M, et al. 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. Sugrue CM, McInerney N, Joyce CW, et al. In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. 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. /*margin-bottom: 43px;*/ A cohort study of breast cancer risk in breast reduction patients. Of 110 subjects who were mailed questionnaires, approximately50 %(61 subjects) provided responses.