Complications and Quality of Life following Gynecomastia Correction in Adolescents and Young Men

Satisfaction and results of the subareolar incision as treatment for gynecomastia in adolescents: experience of two centers

Gynecomastia is a benign glandular proliferation that can affect adolescents causing significant psychological discomfort. Generally, it is idiopathic but underlying endocrinological conditions must be excluded. Different surgical techniques are available, the surgical correction with subareolar incision achieves the goal of satisfactory aesthetic result for patients. We studied all patients treated for gynecomastia in two centers of pediatric surgery. After collection of a detailed family history, we evaluated the presence of early onset of puberty, congenital abnormalities of the external genitalia, use of drugs, eating habits and the presence of genetic disorders. Laboratory tests and ultrasound were made to exclude endocrinological disorders. The surgical treatment was performed by a subareolar incision with gland and adipose tissue excision. A Body - Q chest module to evaluate patient satisfaction has been proposed to everyone before and after surgery. 47 adolescents with median age of 15 years were surgically treated. Three presented endocrinological disorders. Grade of gynecomastia for surgery was: III in 40 patients and IIb in 7 patients. Postoperative complications occurred in 5 patients. The Body - Q chest module was completed by 42 patients and showed good results for all points analyzed, except for social feelings. Gynecomastia in adolescents can be surgically treated with subareolar incision, reporting good aesthetic results and low incidence of complications. Specific tests are useful to assess patient satisfaction.

Comparative analysis of surgical modalities for the gynecomastia treatment: efficiency and aesthetic outcomes

This retrospective study rigorously compares the clinical efficacy of three surgical methodologies for treating gynecomastia while providing guidance for future surgical modality selection. We analyzed records of 77 gynecomastia patients treated between January 2015 and October 2022. Patients were categorized into three groups: Group A (subcutaneous gland resection via areola incision), Group B (liposuction combined with single-hole endoscopic gland resection), and Group C (liposuction combined with three-hole endoscopic gland resection). Parameters assessed included patient demographics, intraoperative bleeding, surgical duration, hospitalization duration, costs, postoperative drainage, complications, and patient satisfaction. Group A had significantly shorter operation time and lower cost than Groups B and C (P < 0.05). There were no significant differences in postoperative drainage (P > 0.05). Group A had a higher incidence of subcutaneous fluid complications. All groups achieved 100% overall postoperative efficiency. Group B demonstrated superior outcomes for scarring and patient satisfaction. All three surgical modalities effectively treat gynecomastia. Circumareolar incision subcutaneous gland resection is optimal for mild to moderate cases due to reduced operation time and cost. Liposuction with single-hole endoscopic gland resection and three-hole endoscopic gland resection offers fewer complications and discreet incisions. Notably, the liposuction and single-hole endoscopic approach yielded superior postoperative patient satisfaction, aligning with minimally invasive principles and warranting broad clinical application.

Risk Factors for Postoperative Complications Following Aesthetic Breast Surgery: A Retrospective Cohort Study of 4973 Patients in China

BACKGROUND

The popularity of aesthetic breast surgery in China results in greater demand for assessing risk factors for complications and mortality.

OBJECTIVES

To determine the incidence and independent risk factors for postoperative complications following aesthetic breast surgery in China.

METHODS

A retrospective cohort study on 4973 patients who had aesthetic breast surgery between 2012 and 2021 was performed. Postoperative complications include minor complications (incision healing impaired, hematoma, or fat liquefaction) and surgical site infection (SSI), which were recorded within 30 days after surgery. The follow-up time was expanded to 1 year only after prosthesis implantation procedures. Potential risk factors including age, weight, length of hospital stay, operation time, volume resection, incision location, and other clinical profile information were evaluated.

RESULTS

Among 4973 patients who underwent aesthetic breast surgery, the minor complication rate was 0.54%, and SSI was 0.68%. Augmentation with prosthesis implantation had the highest SSI rate (4.23%), which was significantly associated with increasing age (relative risk [RR] 1.12; P < 0.01) and periareolar incision (RR 5.87, P < 0.01). After augmentation with autologous fat transplantation, postoperative antibiotic use (RR 6.65, P < 0.01) was an independent risk factor for SSI. After adjusting for weight, volume resection over 1500 g (RR 14.7, P < 0.01) was an independent risk factor for SSI of reduction-mastopexy surgery. The complication rate of reduction mammaplasty (1.01%) and gynecomastia correction was lower (0.75%), and there was no record of complication in mastopexy procedures (n = 161).

CONCLUSION

The incidence of postoperative complications following aesthetic breast surgery is low. Risk factors for complications mainly include increasing age, perioperative antibiotic use, periareolar incision, and extensive volume resection. Much more attention should be focused on those high-risk patients in clinical practice to decrease breast infection.

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 .

Gynecomastia: A systematic review of pharmacological treatments

BACKGROUND

Pubertal gynecomastia (PG), a benign condition with varied reported prevalence, typically appears at 13-14 years-old and is mostly idiopathic and self-limited. Psychologic impairments are common among adolescents with gynecomastia. Surgical intervention is reserved to severe cases and is offered towards the end of puberty. Pharmacological treatment is seldom given by clinicians mainly due to insufficient published data. We conducted this systematic literature review to assess the efficacy, safety, side effects, and complications of pharmacological treatments published.

METHODS

MEDLINE, Embase, and Cochrane CENTRAL were searched for the terms "gynecomastia", "pubertal", and "adolescent" in conjunction with medications from the Selective Estrogen Receptor Modulator (SERM), aromatase inhibitors (AI), and androgens groups in different combinations to optimize the search results. Exclusion criteria included: studies based on expert opinion, similar evidence-based medicine levels studies, and studies which discuss gynecomastia in adults. Selected articles were assessed by two authors. Data collected included: the level of evidence, population size, treatment regimen, follow-up, outcomes, complications, and side effects.

RESULTS

Of 1,425 published studies found and examined meticulously by the authors, only 24 publications met all the study research goals. These were divided into 16 publications of patients treated with SERM, of whom four had AI and four androgens. In general, the data regarding pharmacologic therapy for PG is partial, with insufficient evidence-based research. Tamoxifen and SERM drugs have long been used as treatments for PG. Tamoxifen was the chosen drug of treatment in most of the reviewed studies and found to be effective, safe, and with minimal side effects.

CONCLUSIONS

Pharmacological treatment as a new standard of care has an advantage in relieving behavioral and psychological distress. Although high quality publications are lacking, pharmacological intervention with tamoxifen is appropriate in select patients. Conduction large-scale high-quality studies are warranted with various drugs.