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Flandroy A, Fosseprez P, Pirson GR, Berners A, Servaes M, Deconinck CR. [Treatment of pseudogynecomastia in massive weight loss patients: Liposuction assisted and made-to-measure desepidermization technique]. ANN CHIR PLAST ESTH 2023:S0294-1260(23)00012-2. [PMID: 36966093 DOI: 10.1016/j.anplas.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/04/2023] [Accepted: 02/20/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND After massive weight loss (MWL), the chest in men may show significant deformities. The surgical treatment of gynecomastia after MWL remains a difficult and partially misunderstood surgery due to 4 main factors: a complex excess of skin in height and width that sometimes continues in the axilla or dorsal region, a predominantly fatty rather than glandular component, the malposition of the nipple-areola complex (NAC) that is often enlarged and an inframammary fold (IMF) that is often marked. The techniques currently described are either insufficient or lead to frequent and/or significant complications. The authors describe a new approach that dissociates the treatment of the volume and the skin with a customized resection that is simple, reproducible and safe. Our goal is to improve patient satisfaction while reducing complication rates. METHODS Seventeen patients with adipomastia with excess skin after massive weight loss were operated on using liposuction and skin redraping technique. The authors describe the technique, indications and contraindications of the procedure and analyze the results. RESULTS The average age of the patients was 39 years. The average body mass index (BMI) before weight loss is 42,7kg/m2, the average weight loss before body correction is 49kg, with an average delta of BMI loss of 15,34kg/m2. The average stay in hospital is 1,3 nights. No patient had major complications (hematoma, hemorrhage, necrosis, thrombophlebitis, immediate surgical revision to treat complications). Minor complications including scar dehiscence, infection, steatonecrosis, and distant scar correction were reported in 2 patients, i.e. 11%. CONCLUSION Liposuction assisted and desepidermization torsoplasty is a new technique for correction of pseudogynecomastia in MWL patients. The results are reproductible and the complication rates are low. There is no dead space and therefore no drains are needed. There is little pain and a short hospital stay. This technique is simple, quick and easy to learn. However, it is only applicable in adipomastia. A different technique should be used in the presence of firm glandular tissue.
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Affiliation(s)
- A Flandroy
- Département de chirurgie plastique, reconstructrice et esthétique, CHU UCL, Namur, Belgique
| | - P Fosseprez
- Département de chirurgie plastique, reconstructrice et esthétique, CHU UCL, Namur, Belgique
| | - G R Pirson
- Département de chirurgie plastique, reconstructrice et esthétique, CHU UCL, Namur, Belgique
| | - A Berners
- Département de chirurgie plastique, reconstructrice et esthétique, CHU UCL, Namur, Belgique
| | - M Servaes
- Département de chirurgie plastique, reconstructrice et esthétique, CHU UCL, Namur, Belgique
| | - C R Deconinck
- Département de chirurgie plastique, reconstructrice et esthétique, CHU UCL, Namur, Belgique.
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Innocenti A, Melita D, Dreassi E. Incidence of Complications for Different Approaches in Gynecomastia Correction: A Systematic Review of the Literature. Aesthetic Plast Surg 2022; 46:1025-1041. [PMID: 35138423 PMCID: PMC9411245 DOI: 10.1007/s00266-022-02782-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/09/2022] [Indexed: 11/12/2022]
Abstract
Background Gynecomastia is nowadays a very common disease, affecting a large cohort of patients with different ages. The aim of this literature review is to assess the incidence of complications with all proposed techniques and for combined procedures versus single approach procedures in gynecomastia correction. Materials and Methods A systematic review of the literature was performed to identify all reported techniques for gynecomastia correction covering a period from January 1, 1987 to November 1, 2020. For all selected papers, demographic data, proposed technique, and complications’ incidence have been recorded. Results A total number of 3970 results was obtained from database analysis. A final total number of 94 articles was obtained for 7294 patients analyzed. Patients have been divided into three groups: aspiration techniques, consisting in 874 patients (11,98%), surgical excision techniques, consisting in 2764 patients (37,90%), and combined techniques, consisting in 3656 patients (50,12%). Complications have been recorded for all groups, for a total number of 1407, of which 130 among “Aspiration techniques” group (14,87%), 847 among “Surgical excision techniques” group (30,64%), and 430 in “Combined techniques” group (11,76%). Conclusions Several techniques have been proposed in the literature to address gynecomastia, with the potential to greatly improve self-confidence and overall appearance of affected patients. The combined use of surgical excision and aspiration techniques seems to reduce the rate of complications compared to surgical excision alone, but the lack of unique classification and the presence of several surgical techniques still represents a bias in the literature review. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Hardy KL, Stark R, Small KH, Kenkel JM. An Alternative Treatment of Pseudogynecomastia in Male Patients After Massive Weight Loss. Aesthet Surg J Open Forum 2020; 2:ojaa013. [PMID: 33791640 PMCID: PMC7780471 DOI: 10.1093/asjof/ojaa013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There has been an increase in body contouring procedures following massive weight loss (MWL), including male breast reduction procedures. Treating male chest deformity after MWL using standard mastopexy techniques often leads to suboptimal results. OBJECTIVES The authors describe a technique to treat pseudogynecomastia using a modified elliptical excision and nipple-areola complex (NAC) transposition on a thinned inferior dermal pedicle as an alternative to conventional techniques. METHODS A retrospective chart review from January 2011 to January 2019 identified a total of 14 male patients who underwent excision of pseudogynecomastia using the described technique. RESULTS Patients were characterized by age, method of weight loss, pre-weight loss body mass index (BMI), post-weight loss BMI, total weight loss, grade of pseudogynecomastia, and concurrent procedures performed. Patients were followed for a period ranging from 3 months to 1.5 years (average, 8.1 months). Pre-weight loss BMI and post-weight loss BMI averaged 52.0 kg/m2 and 29.6 kg/m2, respectively. The average weight lost was 79.72 kg and the average total amount of tissue removed was 2615 g. All patients had concurrent procedures with an average operative time of 274 minutes. Four out of 14 patients (28.6%) experienced minor complications, which included asymmetry, delayed wound healing, seroma, and hyperpigmentation. There were no wound infections, hematomas, flap necrosis, or dysesthesia. CONCLUSIONS Due to several cosmetic advantages and low complication profile, our technique using a modified elliptical excision and NAC transfer on an inferior dermal pedicle is an attractive option for treating male chest deformity after MWL. LEVEL OF EVIDENCE 4
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Affiliation(s)
| | | | | | - Jeffrey M Kenkel
- Corresponding Author: Dr Jeffrey M. Kenkel, Professor and Chair, Department of Plastic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA. E-mail: ; Twitter: @drkenkel
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Severe Gynecomastia: New Technique Using Superior Pedicle NAC Flap Through a Circumareolar Approach. Ann Plast Surg 2017; 76:645-51. [PMID: 25003440 DOI: 10.1097/sap.0000000000000229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED : Gynecomastia is defined as benign proliferation of glandular breast tissue in men. Gynecomastia causes considerable emotional discomfort because of limitation of everyday activity especially in young men. Surgical treatment of gynecomastia significantly contributes to an increase in social activity and an improvement of social acceptance and emotional comfort, and thus significantly improves satisfaction from personal life in men who underwent this intervention. Various surgical techniques were suggested to treat gynecomastia, but most of them end with visible scars especially in severe degree gynecomastia. The aim of many plastic surgeons is to advocate new techniques treating severe gynecomastia (grade II B and III according to Simon et al) with less visible scars. OBJECTIVE The author proposed a new technique combining both surgery and liposuction for treating grade II B and III gynecomastia using only circumareolar approach. AIM This study evaluates aesthetic results after surgery and assessment of the incidence of early and late postoperative complications. METHOD The patient was marked preoperatively while standing. Under general anesthesia, ultrasound-assisted liposuction of the periglandular area and de-epithelialization of excess skin were performed. A superiorly based nipple areola complex flap was created based on the subdermal plexus. The excess glandular tissue was resected through the lower half of the circle of the de-epithelialized area. Closure of the wound was done after insertion of 14-French redivac. RESULTS This treatment protocol was applied to 27 patients, 18 to 53 years of age, from February 2008 till now. Among these patients, 4 were classified as type IIB and 23 as type III. Follow-up ranged from 3 months to 4 years. Complications were the following: 1 hematoma, 1 wound dehiscence, 1 loss of nipple areola complex, 2 cases of hypertrophied scars, and 3 minor aesthetic problems near areolae. CONCLUSIONS A new periareolar approach for correction of severe-grade gynecomastia permits broad resection of excess skin and submammary tissue while avoiding unattractive scars on the patient's chest.
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Thiénot S, Bertheuil N, Carloni R, Méal C, Aillet S, Herlin C, Watier E. Postero-Inferior Pedicle Surgical Technique for the Treatment of Grade III Gynecomastia. Aesthetic Plast Surg 2017; 41:531-541. [PMID: 28204931 DOI: 10.1007/s00266-017-0810-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Surgical treatment of Grade III gynecomastia generally utilizes mastectomy techniques and free transplantation of the nipple-areola complex. Moreover, with rising obesity rates and the development of bariatric surgery, an increasing demand for correctional surgery for pseudogynecomastia has been observed, which is comparable to Grade III gynecomastia in terms of its surgical management. Here, we describe an innovative technique to deal with these new demands: fascio-cutaneous flap by postero-inferior pedicle. MATERIALS AND METHODS All patients in the Department of Plastic Surgery from our University Hospital suffering from Grade III gynecomastia or pseudogynecomastia underwent surgery via the postero-inferior pedicle flap technique. Briefly, we performed extensive liposuction of the infero-internal and infero-external mammary quadrants followed by liposuction of the deep tissues of the superior quadrants, except in the area of the pedicle. After removing the skin just above the dermis of the inferior quadrants and performing de-epithelialization of the postero-inferior pedicle flap, the thoracic flap was lowered and the areola transposed. RESULTS Nine patients underwent surgery between March 2015 and March 2016, and their results were collected prospectively. The mean patient age was 46.6 years, the mean weight was 94.2 kg, and the mean body mass index was 30.8 kg/m2. In addition, the mean operative time was 132 min, the mean liposuction volume was 633 mL, the excised weight was 586 g, and the mean hospitalization and drainage durations were 3.8 days. No major complications occurred, no re-intervention was required, and no recurrence was found. CONCLUSIONS We report a new operative technique using a postero-inferior pedicle. Its main advantage is preservation of neurovascular function, which makes this a promising technique for patients who wish to maintain nipple sensitivity. This surgery is reliable and reproducible. We recommend it as the first line treatment for Grade III gynecomastia because of its low rate of major complications and favorable functional and esthetic results. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sophie Thiénot
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.
- SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France.
- STROMAlab, UMR5273 CNRS/UPS/EFS - INSERM U1031, Rangueil Hospital, Toulouse, France.
| | - Raphaël Carloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nicolle Hospital, University of Rouen, Rouen, France
| | - Cécile Méal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Sylvie Aillet
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Christian Herlin
- Department of Plastic and Burn Surgery, CHU of Montpellier, Montpellier, France
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
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Brown RH, Chang DK, Siy R, Friedman J. Trends in the Surgical Correction of Gynecomastia. Semin Plast Surg 2015; 29:122-30. [PMID: 26528088 PMCID: PMC4621393 DOI: 10.1055/s-0035-1549053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited in their inability to address significant skin excess and ptosis. For mild to moderate gynecomastia, newer techniques using arthroscopic morcellation and endoscopic techniques promise to address the fibrous component, while minimizing scar burden by utilizing liposuction incisions. Nevertheless, direct excision through periareolar incisions remains a mainstay in treatment algorithms for its simplicity and avoidance of additional instrumentation. This is particularly true for more severe cases of gynecomastia requiring skin resection. In the most severe cases with significant skin redundancy and ptosis, breast amputation with free nipple grafting remains an effective option. Surgical treatment should be individualized to each patient, combining techniques to provide adequate resection and optimize aesthetic results.
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Affiliation(s)
- Rodger H. Brown
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Daniel K. Chang
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Richard Siy
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Jeffrey Friedman
- Division of Plastic Surgery, and Plastic and Reconstructive Surgery, The Methodist Hospital, Houston, Texas
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Sarkar A, Bain J, Bhattacharya D, Sawarappa R, Munian K, Dutta G, Naiyer GJ, Ahmad S. Role of Combined Circumareolar Skin Excision and Liposuction in Management of High grade Gynaecomastia. J Cutan Aesthet Surg 2014; 7:112-6. [PMID: 25136214 PMCID: PMC4134643 DOI: 10.4103/0974-2077.138354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION High-grade gynaecomastia (Simon IIb and III) has tissue excess (skin excess, enlarged areola, and displaced nipple), which is best managed surgically; however, results of conventional breast reduction surgeries and liposuction is not very good. Aim of our study was to describe a combined technique to manage these problems to produce a good result. MATERIAL AND METHOD This was a 2-year study among 12 patients of high grade gynaecomastia. Clinical and laboratory findings were normal. Pre-operatively in standing position, diameter of breast and areola, position of nipple, and amount of skin excess were marked. Under general anaesthesia, tumescent infiltration, circumareolar de-epithelisation of skin excess, and liposuction was completed. Redundant portion of the breast was sharply dissected and pulled out. Areola was fixed over pectoralis fascia at mid humerus level, just medial to the mid-clavicular line. Outer borders of the de-epithelised area were apposed by the purse-string effect of a subdermal suture, and further apposed by few half buried horizontal mattress sutures. Drains for 24 hour and compressive dressings for 6 weeks were used. RESULT Mean age of presentation was 25.8 year; emotional discomfort was the chief complaint. Among 12 patients, 10 patients had bilateral gynaecomastia and 8 patients had enlarged and displaced nipple-areola complex. Average hospital stay was 2.41 days and recoveries were usually uneventful. CONCLUSION The problem of tissue excess and tissue displacement in high grade gynaecomastia can be well managed by this combined circumareolar skin reduction and liposuction technique to achieve a scar-less flat male chest.
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Affiliation(s)
- Arindam Sarkar
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Jayanta Bain
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Debtanu Bhattacharya
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Raghavendra Sawarappa
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Kinkar Munian
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Gouranga Dutta
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Ghulam Jeelani Naiyer
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Shamshad Ahmad
- Department Preventive and Social Medicine, PGIMSR & ESIC Medical College, Kolkata, West Bengal, India
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Lee JC, Lee YS, Park ES. Surgical Treatment of Severe Gynecomastia Using The Horizontal Ellipse Method. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2013. [DOI: 10.14730/aaps.2013.19.1.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Joo Chul Lee
- Department of Plastic & Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Korea
| | | | - Eun Soo Park
- Department of Plastic & Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Korea
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Maetz B, Bodin F, Abbou R, Wilk A, Bruant-Rodier C. [Management of weight loss consequences in the male chest: The amputation grafting technique with a L scar]. ANN CHIR PLAST ESTH 2012; 58:650-7. [PMID: 23021838 DOI: 10.1016/j.anplas.2012.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 07/20/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Following the upsurge in cases of morbid obesity and bariatric surgery, there is after massive weight loss effects of the thorax in man such as pseudogynecomastia extremely poorly tolerated by patients. Treatment aims to correct the excess skin while optimizing the location and quality of scars. Turning our back on techniques derived from mammoplasty, we go into these major forms for mastectomy with grafting the areolo-mammelonar plate and resulting scar in L extended if needed until the axilla. MATERIALS AND METHODS From 2005 to 2011, we performed 12 mastectomies after massive weight loss (45 kg on average). Patients aged 19 to 64 had an average BMI of 29.2. In five patients, we had started the move by liposuction (190 cc average per side). The mastectomy was performed by placing the scar at the lower edge of the pectoralis major. The areolas previously harvested were placed on the axis of the graft within two to three centimeters above the scar. All patients were reviewed and evaluated in consultation questionnaire with an average follow up of 2 years (6 months-5 years). RESULTS The average volume of resection was 560 g per side (55 g-2500 g), operative time 155 minutes. Complications consisted of hematoma requiring surgical revision and delayed wound healing in three over 1 month with partial areola necrosis. The overall patient satisfaction was excellent with no secondary correction request. CONCLUSION In the major pseudogynecomastia, the option is taken immediately for a mastectomy technique which scar is located at the basis of the thorax and may include an axillary extension in L. It effectively corrects the large cutaneous and fat surplus and restores in one time a flat male chest. Satisfaction is high and patients are no more ashamed to expose their chest.
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Affiliation(s)
- B Maetz
- Service de chirurgie plastique et maxillo-faciale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
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Barros ACSDD, Sampaio MDCM. Gynecomastia: physiopathology, evaluation and treatment. SAO PAULO MED J 2012; 130:187-97. [PMID: 22790552 PMCID: PMC10876201 DOI: 10.1590/s1516-31802012000300009] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 07/11/2011] [Accepted: 12/27/2011] [Indexed: 11/21/2022] Open
Abstract
Gynecomastia (GM) is characterized by enlargement of the male breast, caused by glandular proliferation and fat deposition. GM is common and occurs in adolescents, adults and in old age. The aim of this review is to discuss the pathophysiology, etiology, evaluation and therapy of GM. A hormonal imbalance between estrogens and androgens is the key hallmark of GM generation. The etiology of GM is attributable to physiological factors, endocrine tumors or dysfunctions, non-endocrine diseases, drug use or idiopathic causes. Clinical evaluation must address diagnostic confirmation, search for an etiological factor and classify GM into severity grades to guide the treatment. A proposal for tailored therapy is presented. Weight loss, reassurance, pharmacotherapy with tamoxifen and surgical correction are the therapeutic options. For long-standing GM, the best results are generally achieved through surgery, combining liposuction and mammary adenectomy.
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Stoff A, Velasco-Laguardia FJ, Richter DF. Central Pedicled Breast Reduction Technique in Male Patients After Massive Weight Loss. Obes Surg 2011; 22:445-51. [DOI: 10.1007/s11695-011-0583-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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