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Lashin R, Youssef RA, Elshahat A, Mohamed EN. Postoperative Psychological Impact on Teenagers after Gynecomastia Correction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5094. [PMID: 37361507 PMCID: PMC10287129 DOI: 10.1097/gox.0000000000005094] [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] [Received: 03/16/2023] [Accepted: 05/05/2023] [Indexed: 06/28/2023]
Abstract
Gynecomastia is common among teenagers. Most published research focused on how surgery is effective in enhancing the aesthetic appearance of the breast. Limited information is already known about the psychosocial benefits of surgical interventions. This study explores and assesses the surgical, cosmetic, and psychological outcome of gynecomastia correction in teenagers. Methods This prospective study included 20 teenagers with Simon grade IIA gynecomastia. The assessment included complications, patients' satisfaction, Manchester Scar Scale, and Li et al questionnaire at 12 months postoperative. Rosenberg Self-Esteem Scale, 36-Item Short Form Survey (SF-36) for quality of life, and school achievement level were evaluated 1 month preoperative and 12 months postoperative. Statistical analysis was done. Results Patients were aged 13-19 years old. The follow-up period was 12 ± 36 months. Postoperative complications included seroma formation (n = 1) and mild asymmetry (n = 3). Results were "uniformly good to excellent" on a satisfaction scale. The Manchester Scar Scale shows the lowest score, which denotes the highest outcomes. The Li et al questionnaire showed a positive overall change. Comparing Rosenberg Scale scores pre- and postoperatively revealed higher scores postoperatively, which indicate higher self esteem. Comparing SF-36 pre- and postoperatively showed a significant increase in postoperative quality of life. Comparing school achievement pre- and postoperatively showed marked improvement postoperatively. Results were highly statistically significant. Conclusions Surgical treatment of teenage gynecomastia is beneficial for different psychosocial domains. Pull-through of the mammary gland combined with liposuction provides satisfactory cosmetic results. Patients who underwent surgery reported a significant improvement in psychosocial load, better school achievement, higher quality of life, and better self-esteem.
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Affiliation(s)
- Riham Lashin
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ramy A. Youssef
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Elshahat
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman Nagy Mohamed
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Complications and Quality of Life following Gynecomastia Correction in Adolescents and Young Men. Plast Reconstr Surg 2022; 149:1062e-1070e. [PMID: 35349529 DOI: 10.1097/prs.0000000000009089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Persistent adolescent gynecomastia negatively affects health-related quality of life. Surgery results in psychosocial improvements, but the effects of postoperative complications on health-related quality of life are unknown. The authors examined whether complications following adolescent gynecomastia surgery impact postoperative health-related quality of life. METHODS Patients aged 12 to 21 years who underwent surgical correction of unilateral/bilateral gynecomastia between 2007 and 2019 were enrolled (n = 145). Relevant demographic and clinical data were obtained from medical records. Fifty-one patients completed the following surveys preoperatively, and at 6 months and 1, 3, 5, 7, 9, and 11 years postoperatively: 36-Item Short-Form Health Survey (Version 2), Rosenberg Self-Esteem Scale, and the 26-item Eating Attitudes Test. RESULTS Within a median period of 8.6 months, 36 percent of breasts experienced at least one complication. The most common were residual tissue (12.6 percent), contour irregularities (9.2 percent), and hematomas (7.8 percent). Patients reported significant postoperative improvements in self-esteem and in seven health-related quality-of-life domains (Physical Functioning, Role-Physical, Bodily Pain, Vitality, Social Functioning, Role-Emotional, and Mental Health) at a median of 33.3 months. Postoperative survey scores did not vary by grade or procedure, or largely by body mass index category or complication status. However, patients aged younger than 17 years at surgery scored significantly higher than older patients in the Short-Form Health Survey Vitality and Mental Health domains postoperatively. CONCLUSIONS Health-related quality-of-life improvements are achievable in adolescents through surgical correction of persistent gynecomastia. Postoperatively, patients largely experienced similar health-related quality-of-life gains irrespective of complication status, grade, surgical technique, or body mass index category. Minor postcorrection complications are but do not appear to limit postoperative health-related quality-of-life benefits.
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Jørgensen MG, Cho BY, Hansen FG, Schmidt VJ, Sørensen JA, Toyserkani NM. Patients Decision-Making Characteristics Affects Gynecomastia Treatment Satisfaction: A Multicenter Study Using the BODY-Q Chest Module. Aesthetic Plast Surg 2021; 46:1053-1062. [PMID: 34704122 DOI: 10.1007/s00266-021-02633-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient satisfaction is the most critical outcome in gynecomastia treatment. However, patient satisfaction may be affected by the patient's decision-making trait, such as exhaustively searching for the best outcome or being content with an outcome that satisfies a preconceived requirement. OBJECTIVE To assess whether patient's decision-making characteristic affect their satisfaction with gynecomastia treatment. METHODS This was a cross-sectional study including patients treated for gynecomastia between January 2009 and December 2019 at two tertiary hospitals in Denmark. Alive patients were sent the BODY-Q: Chest module, the SF-36 questionnaire, and the Maximizer/Satisficer decision-making survey. Patients were classified as Maximizers if they scored more than 40 points on the Maximizer/Satisficer survey. Percentage score differences (PDs) in quality of life scales were calculated between Maximizers and Satisficers. RESULTS In total, 192 gynecomastia patients were included in this study and classified as Maximizers (n = 152) or Satisficers (n = 40). Maximizers were younger and more had gynecomastia following abuse of anabolic steroids than Satisficers (p < 0.05). With respect to bodily satisfaction, Maximizers showed significantly worse satisfaction with nipples (PDs: - 12.98%), psychological function (PDs: - 13.68%) and social function (PDs: - 8.77%, p < 0.05). In addition, Maximizers had significantly worse emotional role functioning (- 11.03%), vitality (PDs: - 11.72%) and mental health (PDs: - 10.00%, p < 0.05). CONCLUSION Patients exhibiting maximizing-type decision-making characteristics have worse satisfaction with gynecomastia treatment and poorer psychosocial health. This information may facilitate patient counseling and alignment of treatment expectations. 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)
- Mads Gustaf Jørgensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Odense, Denmark.
- Clinical Institute, University of Southern Denmark, Odense, Denmark.
- Open Patient data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark.
| | - Bu Youn Cho
- Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Copenhagen University, Roskilde, Denmark
| | - Frederik Gulmark Hansen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Odense, Denmark
| | - Volker-Jürgen Schmidt
- Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Copenhagen University, Roskilde, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Navid Mohamadpour Toyserkani
- Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Copenhagen University, Roskilde, Denmark
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
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Insurance Policy Trends for Breast Surgery in Cisgender Women, Cisgender Men, and Transgender Men. Plast Reconstr Surg 2019; 144:334e-336e. [DOI: 10.1097/prs.0000000000005852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nuzzi LC, Firriolo JM, Pike CM, Cerrato FE, DiVasta AD, Labow BI. The Effect of Surgical Treatment for Gynecomastia on Quality of Life in Adolescents. J Adolesc Health 2018; 63:759-765. [PMID: 30279103 DOI: 10.1016/j.jadohealth.2018.06.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Despite the psychosocial deficits associated with gynecomastia, surgical treatment of adolescent gynecomastia remains controversial. This longitudinal cohort study measures changes in health-related quality of life following surgical treatment of gynecomastia in adolescents. METHODS The following surveys were administered to adolescents with gynecomastia and male controls, aged 12-21 years: Short-Form 36v2 (SF-36), Rosenberg Self-Esteem Scale (RSES), and Eating-Attitudes Test-26. Subjects completed surveys at baseline and postoperatively/at follow-up at 6 months, 1 year, 3 years, and 5 years. RESULTS From 2008 to 2017, 44 patients undergoing surgical treatment of gynecomastia and 64 unaffected male controls participated in our study. At baseline, gynecomastia patients scored significantly worse than controls on the RSES and in five SF-36 domains: general health, vitality, social functioning, role-emotional, and mental health. Scores significantly improved postoperatively on the RSES, and in four SF-36 domains: physical functioning, role-physical, bodily pain, and social functioning. Postoperatively, gynecomastia subjects scored similarly to controls in all SF-36 domains and the RSES. Young and overweight/obese patients and those with severe gynecomastia had the greatest postoperative improvement across survey measures. CONCLUSIONS Surgical treatment of gynecomastia significantly improves the quality of life of adolescents, with measurable improvements in physical and psychosocial functioning. Postoperatively, gynecomastia patients performed comparably to unaffected controls. Surgical treatment of gynecomastia in adolescents and young men has the potential to significantly improve quality of life, particularly in younger and overweight/obese patients and those with moderate to severe gynecomastia. Concerns regarding patient age and body mass index alone should not contraindicate surgery.
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Affiliation(s)
- Laura C Nuzzi
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph M Firriolo
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carolyn M Pike
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Felecia E Cerrato
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amy D DiVasta
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian I Labow
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
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Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Gland Surg 2018; 7:S70-S76. [PMID: 30175067 DOI: 10.21037/gs.2018.03.09] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Gynecomastia affects up to two-thirds of the male population. For many patients the psychological impact of the disease is substantial. Surgical treatment is indicated when medical treatments fail. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Little is known about the effect of surgical treatment on the psychological aspects of the disease. The aim of this review was to identify the psychological domains affected by the disease and the effect of surgical treatment on these. A systematic search of the published literature was performed. All studies on the subject were evaluated for inclusion and six studies were included in the review. Several of the included studies reported improvement in quality of life and several psychological domains after surgical treatment for gynecomastia. Among these domains, are; vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Impact of surgical treatment for gynecomastia seems to be beneficial for several psychological domains. The current level of evidence on this subject is very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. More data on this subject could improve the pre-operative evaluation of these patients and help identify the patients that will benefit from treatment.
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Affiliation(s)
- Martin Sollie
- Department of Plastic Surgery, Odense University Hospital, Odense C, Denmark
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7
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Abstract
PURPOSE OF REVIEW Our aim is to review the steps of diagnosis and management of gynecomastia with a special focus on treatment of gynecomastia associated with androgen deprivation therapy for prostate cancer. RECENT FINDINGS Recent studies investigating tamoxifen and radiation therapy for both therapy and prophylaxis of bicalutamide-induced gynecomastia are reviewed. Gynecomastia is a common clinical problem, affecting between one and two thirds of middle-aged men. Diagnosis is typically made by history and physical exam. Common causes include chronic medical conditions and medications; however, unexplained gynecomastia should prompt laboratory work-up, followed by appropriate imaging studies to evaluate for hormone producing cancers. For patients taking bicalutamide for treatment of prostate cancer, tamoxifen or radiation therapy for gynecomastia are excellent options.
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Barone M, Cogliandro A, Morelli Coppola M, Cassotta G, Di Stefano N, Tambone V, Persichetti P. Patient-reported outcome measures following gynecomastia correction: a systematic review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1375-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
OBJECTIVE To evaluate the results of surgical treatment of gynecomastia in the context of quality of life and satisfaction after the surgery. METHODS Fifty male patients (mean age, 25.1 years [SD = 8 years]) who underwent surgery for gynecomastia and completed both (preoperative and postoperative) stages of the study were included in the analysis. The quality-of-life evaluation instrument was The Short Form-36 Health Survey Questionnaire. Additionally, we used a short questionnaire including 2 questions about patient satisfaction with gynecomastia surgery. RESULTS The overall change in life satisfaction after gynecomastia surgery was 1 point on Likert scale (sign test, P < 0.0001). Participants after gynecomastia surgery scored significantly higher than before the procedure in all Short Form-36 Health Survey Questionnaire domains as well as in 2 main scales Psychical and Physical Health. The changes were especially visible for the domain social functioning and a scale Psychical Health (P < 0.0001). CONCLUSIONS Gynecomastia surgery significantly improved men's life quality in all aspects and especially in the social aspect and psychical health. This indicates that adult men with gynecomastia are a specific group of patients, in which surgery may result in life quality improvement even over the average scores.
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Choi BS, Lee SR, Byun GY, Hwang SB, Koo BH. The Characteristics and Short-Term Surgical Outcomes of Adolescent Gynecomastia. Aesthetic Plast Surg 2017; 41:1011-1021. [PMID: 28451801 DOI: 10.1007/s00266-017-0886-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most adolescent gynecomastia is resolved spontaneously in 3 years. But, persistent gynecomastia could have a negative influence on psychoemotional development on adolescence. The purpose of this study is to report the characteristics of adolescent gynecomastia patients who received the surgeries, and discuss the short-term surgical outcomes. METHODS Of the 1454 patients who underwent gynecomastia surgery at Damsoyu hospital from January 2014 to May 2016, 71 were adolescents. Subcutaneous mastectomy with liposuction was performed for adolescent patients who had gynecomastia for more than 3 years and showed psychosocial distress. Demographic and outcome variables were retrospectively analyzed. RESULTS The mean age was 17.5 ± 0.77 years old. All gynecomastia cases were bilateral. Simon's grade IIa (35 patients, 49.3%) was the most common, and grade III was not observed. Fifty-one patients (71.8%) were classified as having a glandular-type breast component. Fourteen patients (19.7%) had complications, but only 3 cases (4.2%) required revision. Most of the patients (70 patients, 98.6%) were satisfied with the esthetic results, and the average 5-point Likert score was 4.85 ± 0.40. Recurrence was not observed. As the Simon's grade increased from I to IIA, a higher BMI, larger amounts of breast tissue, and longer operation times were observed. CONCLUSIONS Gynecomastia that did not regress spontaneously was mostly the glandular type, so not only liposuction but also surgical removal of glandular tissue is necessary. Surgical treatment, selectively performed in patients who have had gynecomastia for 3 years, and have experienced psychosocial distress, could be an acceptable treatment for adolescent gynecomastia. 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)
- Byung Seo Choi
- Department of Surgery, Damsoyu Hospital, 213 Bongeunsa-ro, Gangnam-gu, Seoul, Korea
| | - Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital, 213 Bongeunsa-ro, Gangnam-gu, Seoul, Korea.
| | - Geon Young Byun
- Department of Surgery, Damsoyu Hospital, 213 Bongeunsa-ro, Gangnam-gu, Seoul, Korea
| | - Seong Bae Hwang
- Department of Surgery, Damsoyu Hospital, 213 Bongeunsa-ro, Gangnam-gu, Seoul, Korea
| | - Bum Hwan Koo
- Department of Surgery, Damsoyu Hospital, 213 Bongeunsa-ro, Gangnam-gu, Seoul, Korea
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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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Zavlin D, Jubbal KT, Friedman JD, Echo A. Complications and Outcomes After Gynecomastia Surgery: Analysis of 204 Pediatric and 1583 Adult Cases from a National Multi-center Database. Aesthetic Plast Surg 2017; 41:761-767. [PMID: 28341949 DOI: 10.1007/s00266-017-0833-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/21/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gynecomastia is a common disease that is prevalent across all age groups of boys and men. Although benign in nature, it can lead to psychological and social distress, prompting affected patients to seek medical attention. Management strategies include observation and drug therapy, yet surgical procedures remain the hallmark of treatment. The goal of this study was to analyze patient demographics, outcomes, and complication rates of gynecomastia surgery in a large multi-institutional cohort. METHODS We performed a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases to produce two cohorts that underwent gynecomastia surgical repair. The two populations were compared for comorbidities, perioperative details, and complication rates. Multivariate analyses helped detect risk factors associated with adverse events. RESULTS A total of 204 pediatric and 1583 adult male patients were identified in our analysis. Mean ages were 15.8 and 39.6 years, respectively. A BMI of 28.2 in the latter cohort revealed an overweight adult population. Preoperative comorbidities (0.0-4.9% in children, 0.0-6.4% in adults) and American Society of Anesthesiologists scores (ASA 1 + 2: 98.5 and 82.7%) symbolized a healthy population. Procedures were subsequently performed mostly as outpatient (84.3 and 93.9%) and with short hospitalization durations (0.27 and 0.06 days). Our results demonstrated low surgical (3.9 and 1.9%) and medical (0.0 and 0.3%) complications within the standardized 30-day postoperative period. Children and adolescents, however, required double mean operative times compared to adults (111.3 vs 56.7 min). CONCLUSION Operative gynecomastia treatment remains a safe treatment modality across all age groups. Patients with known preoperative medical or surgical comorbidities necessitate more extensive perioperative assessment and monitoring. 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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Affiliation(s)
- Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA.
| | - Kevin T Jubbal
- San Diego School of Medicine, University of California, La Jolla, CA, USA
| | - Jeffrey D Friedman
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA
| | - Anthony Echo
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA
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Stevens RJ, Stevens SG, Rusby JE. The “postcode lottery” for the surgical correction of gynaecomastia in NHS England. Int J Surg 2015; 22:22-7. [DOI: 10.1016/j.ijsu.2015.07.688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 07/22/2015] [Accepted: 07/27/2015] [Indexed: 11/25/2022]
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Ordaz DL, Thompson JK. Gynecomastia and psychological functioning: A review of the literature. Body Image 2015; 15:141-8. [PMID: 26408934 DOI: 10.1016/j.bodyim.2015.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 01/22/2023]
Abstract
Gynecomastia is defined as excess glandular growth of breast tissue in males. It is a noticeable physical difference that commonly affects males in adolescence and old age. While often transient in nature, gynecomastia persists indefinitely in 10% of cases. Much of the literature on gynecomastia has focused on etiology and management. Little research has been done regarding the impact of gynecomastia on one's mental health and quality of life; however, some studies have suggested various psychosocial and psychological consequences related to gynecomastia. These consequences include but are not limited to depression, anxiety, disordered eating, body dissatisfaction, and reduced self-esteem. The aims of this paper are to review the current gynecomastia literature, bring awareness to an understudied but troubled population, and discuss directions for future work, including offering extant models of body image to guide researchers.
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Affiliation(s)
- D Luis Ordaz
- Department of Psychology, University of South Florida, Tampa, FL, USA.
| | - J Kevin Thompson
- Department of Psychology, University of South Florida, Tampa, FL, USA
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Fagerlund A, Cormio L, Palangi L, Lewin R, Santanelli di Pompeo F, Elander A, Selvaggi G. Gynecomastia in Patients with Prostate Cancer: A Systematic Review. PLoS One 2015; 10:e0136094. [PMID: 26308532 PMCID: PMC4550398 DOI: 10.1371/journal.pone.0136094] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/29/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Gynecomastia and/or mastodynia is a common medical problem in patients receiving antiandrogen (bicalutamide or flutamide) treatment for prostate cancer; up to 70% of these patients result to be affected; furthermore, this can jeopardise patients' quality of life. AIMS To systematically review the quality of evidence of the current literature regarding treatment options for bicalutamide-induced gynecomastia, including efficacy, safety and patients' quality of life. METHODS The PubMed, Medline, Scopus, The Cochrane Library and SveMed+ databases were systematically searched between January 1, 2000 and December 31, 2014. All searches were undertaken between January and February 2015. The search phrase used was:"gynecomastia AND treatment AND prostate cancer". Two reviewers assessed 762 titles and abstracts identified. The search and review process was done in accordance with the PRISMA statement. The PICOS (patients, intervention, comparator, outcomes and study design) process was used to specify inclusion criteria. Quality of evidence was rated according to GRADE. MAIN OUTCOME MEASURES Primary outcomes were: treatment effects, number of complications and side effects. Secondary outcome was: Quality of Life. RESULTS Eleven studies met the inclusion criteria and are analysed in this review. Five studies reported pharmacological intervention with tamoxifen and/or anastrozole, either as prophylactic or therapeutic treatment. Four studies reported radiotherapy as prophylactic and/or therapeutic treatment. Two studies compared pharmacological treatment to radiotherapy. Most of the studies were randomized with varying risk of bias. According to GRADE, quality of evidence was moderate to high. CONCLUSIONS Bicalutamide-induced gynecomastia and/or mastodynia can effectively be managed by oral tamoxifen (10-20 mg daily) or radiotherapy without relevant side effects. Prophylaxis or therapeutic treatment with tamoxifen results to be more effective than radiotherapy.
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Affiliation(s)
- Anders Fagerlund
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Lina Palangi
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Richard Lewin
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Anna Elander
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gennaro Selvaggi
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden
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Rew L, Young C, Harrison T, Caridi R. A systematic review of literature on psychosocial aspects of gynecomastia in adolescents and young men. J Adolesc 2015; 43:206-12. [DOI: 10.1016/j.adolescence.2015.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 06/13/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
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Fagerlund A, Lewin R, Rufolo G, Elander A, Santanelli di Pompeo F, Selvaggi G. Gynecomastia: A systematic review. J Plast Surg Hand Surg 2015; 49:311-8. [DOI: 10.3109/2000656x.2015.1053398] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Paula HRD, Haddad A, Weiss MA, Dini GM, Ferreira LM. Translation, cultural adaptation, and validation of the American Skindex-29 quality of life index. An Bras Dermatol 2014; 89:600-7. [PMID: 25054747 PMCID: PMC4148274 DOI: 10.1590/abd1806-4841.20142453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 08/15/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Measuring the quality of life measure of patients with dermatologic diseases
is an important concern. The instruments to evaluate it are commonly
originally written in English and need to be translated and validated to be
used in different cultures. OBJECTIVE The purpose of this paper is to translate and validate the Skindex-29
questionnaire to Brazilian Portuguese to be used in our country as a quality
of life assessment instrument in dermatologic patients. METHODS The first step was the translation from English to Brazilian Portuguese and
the back-translation by two native speakers. The translated version was then
used for the second step, when three questionnaires were applied to 75
patients (43 of whom were classified as lightly affected and 32 as heavily
affected by their dermatologic conditions): an identification questionnaire,
the translated version of Skindex-29, and the Brazilian Portuguese version
of Dermatologic Life Quality Index (DLQI). Additionally, the generic
questionnaire Short Form 36 (SF-36) was applied to 41 of these patients. The
last step to evaluate reproducibility was repeating the Skindex-29
questionnaire by the same researcher one week later in 44 patients. RESULTS Reliability was observed in global Skindex-29 scale (α=0.934), and its
domains emotions (α=0.926), symptoms (α=0,702), and psycosocial functioning
(α=0.860). The reproducibility showed high intraclass correlations. High
intra class correlations was observed, thus validating reliability. CONCLUSIONS The Skindex-29 quality of life questionnaire was properly translated and
validated to Brazilian Portuguese.
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Abstract
BACKGROUND The purpose of this study was to determine the physical and psychosocial impact of gynecomastia and its severity on adolescents seeking treatment as compared with healthy adolescent males. METHODS The following surveys were administered to adolescents with gynecomastia and healthy male controls, aged 12 to 21 years: Short Form-36 Version 2, the Rosenberg Self-Esteem Scale, and the Eating Attitudes Test-26. Demographic variables were compared between the two groups, and controls were administered a short chest symptoms survey. Linear regression models, unadjusted and adjusted for body mass index category, were fit to determine the effect of case status and graded severity of gynecomastia on survey score. RESULTS Forty-seven patients with gynecomastia and 92 male control subjects participated in this study. There was no difference in mean age between the groups, although patients with gynecomastia had a significantly higher body mass index. Gynecomastia subjects had three lower Short Form-36 domain and Rosenberg Self-Esteem Scale scores independent of body mass index category as compared with controls, although there was no difference in Eating Attitudes Test-26 scores between the groups. Graded gynecomastia severity had no effect on survey scores, all independent of body mass index category. CONCLUSIONS Gynecomastia has a significant negative impact on primarily the psychosocial well-being of affected adolescent patients, specifically in regard to social functioning, mental health, and self-esteem. Psychosocial impact was not affected by graded severity of disease. Health care providers and patients should be aware of the psychosocial impairments associated with gynecomastia and consider early treatment for adolescents suffering from this condition, regardless of severity.
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He Q, Zheng L, Zhuang D, Fan Z, Xi C, Zhou P. Surgical treatment of gynecomastia by vacuum-assisted biopsy device. J Laparoendosc Adv Surg Tech A 2011; 21:431-4. [PMID: 21561329 DOI: 10.1089/lap.2011.0019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Gynecomastia is a benign clinical condition that is the unilateral or bilateral enlargement of the male breast, but sometimes it causes serious psychological and physical stress in young men and brings about phobia of malignancy in elderly men. Minimally invasive and functional therapy represents an inevitable trend in breast surgery. We investigated the feasibility and safety of vacuum-assisted biopsy device in treating gynecomastia. METHODS From January 2006 to January 2010, 20 male patients with gynecomastia were treated by an 8-gauge vacuum-assisted biopsy device. The average age was 24.7 years (range, 18-47 years). RESULTS The operation was successfully performed in all 20 patients with a mean operating time of 51 minutes and a hospital stay of 4 days. Postoperative complications included 1 case of hematoma, but no nipple necrosis, local skin necrosis, or skin buttonhole occurred. No other operation-related complications were observed. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6-48 months. CONCLUSIONS Treatment of gynecomastia by the Mammotome device is distinctive, practicable in manipulation, safe, and can achieve excellent cosmetic results. The Mammotome procedure simply represents another novel treatment option for gynecomastia.
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Affiliation(s)
- Qingqing He
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital, Jinan, The People's Republic of China.
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Piggott JR, Yazdani A. Bilateral Pulmonary Emboli After Bilateral Mastectomy in a 15-Year-Old Boy with Hypogonadism: A Case Report. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2010. [DOI: 10.1177/229255031001800404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary emboli are rare, yet serious, complications of body contouring surgery. When they occur, they more often follow as complications of long, invasive procedures in adults. The present report details a case of bilateral pulmonary emboli in an obese 15-year-old boy with hypogonadism undergoing bilateral mastectomy for gynecomastia. The diagnosis of bilateral pulmonary emboli was made on the basis of clinical presentation and positive ventilation/perfusion scan. The patient responded well to heparin anticoagulation treatment. The relevance of pediatric obesity, pediatric body contouring surgery and the risk of thromboembolic events in pediatric patients are discussed.
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Affiliation(s)
- JR Piggott
- Victoria Hospital, London Health Sciences Centre, London, Ontario
| | - Arjang Yazdani
- Victoria Hospital, London Health Sciences Centre, London, Ontario
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