How important is "pseudogynecomastia"?

Minimal Incision Technique for Gynecomastia

Background:

Gynecomastia or enlargement of the male breasts affects a large proportion of males, with most patients requiring surgical intervention as only a few lesions are actually resolved with medical management alone. Surgery cures the patients of their problems, albeit, at the cost of scarring and other cosmetic problems in some patients. Therefore, refinements in the surgical process are still ongoing so as to provide the best results with minimal scarring.

Aims and Objectives:

To find out the feasibility of a minimal incision technique for glandular excision after liposuction in patients with gynecomastia so as to decrease the final visible scars in these patients.

Materials and Methods:

From July 2018 to September 2018, eight patients were subjected to gynecomastia surgery employing liposuction and gland removal through a single transverse 5–7 mm incision in the nipple. All the patients subjected to this technique had Grade IIa gynecomastia as per Simon’s scale. The Global Aesthetic Improvement Scale, comprising a 5-point Likert scale, was employed to find out the satisfaction level of the patients 12 months after surgery; this level was compared with that of a similar population of patients being operated on by employing liposuction and subcutaneous mastectomy by the periareolar technique.

Results:

The mean operating time was 110 min, and there was minimal bleeding during the procedure. Complications were also negligible, and all patients achieved an excellent chest contour with restoration of protective nipple sensation when evaluated 12 months after surgery. The difference in mean between the 2 patient groups was 0.125 with a p-value of 0.64.

Conclusions:

Glandular excision through a single transverse incision made through the nipple is a safe approach in selected patients and it produces excellent cosmetic outcomes. However, it requires patience on the part of the surgeon to achieve the desired goals of the surgery.

Management of Adolescent Gynecomastia: An Update

Gynecomastia refers to an enlargement of the male breast caused by benign proliferation of the glands ducts and stromal components including fat. It is the most common form of breast swelling seen in adolescent males. During pubertal development, gynecomastia can develop as a result of transient relative imbalances between androgens and estrogens. Pubertal gynecomastia is self-limited in 75 to 90% of adolescents and regresses over 1 to 3 years. However it may cause significant psychological stress and depression in adolescents. For boys with persistent gynecomastia that is causing substantial tenderness or embarrassment a tailored approach of close follow-up and use of anti-estrogen drugs may be recommended. These drugs block the effects of estrogens in the body and can reduce the size of the breasts somewhat. It appears that pharmacological therapy of persistent adolescent gynecomastia is reasonable effective if given early in the course of the disease and more successful in cases with small or moderate breast enlargement. However, neither of these drugs is universally approved for the treatment of gynecomastia because the risks and benefits have not been studied completely. Surgical approach may be needed under special conditions for cosmetic reasons. In this update, we review the different published trials for managing adolescent gynecomastia. (www.actabiomedica.it)