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Asal M, Ewedah M, Bassiony M, Abdelatif A. Liposuction and port site nipple sparing mastectomy: an alternative method for the operative treatment of gynecomastia at Alexandria main university hospital. BMC Surg 2023; 23:244. [PMID: 37605230 PMCID: PMC10441726 DOI: 10.1186/s12893-023-02146-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Gynecomastia is characterized by unusually large masses that radiate concentrically from the base of the nipple and is caused by abnormal growth of the glandular tissue of the male breast. An alternative strategy for the surgical treatment of gynecomastia was used in this experimental study, which aims to use liposuction and port site nipple sparing mastectomy. METHODS The study was conducted in the surgical oncology unit at Alexandria Main University Hospital included 103 patients with a mean age of 27 and no medical history. 100 patients had bilateral gynecomastia, and three patients had unilateral gynecomastia,with two having it on the right side and one on the left. RESULTS Among the 103 participants, 83 had grade II gynecomastia and 20 had grade I. Only one of the three patients who participated in the study had an expanding hematoma on one side that needed to be surgically evacuated in the operating room. None of our patients experienced an infection or seroma following surgery. Furthermore, only three of our patients experienced nipple areolar complicated superficial epidermolysis, which need regular dressings until recovery. Of the 103 patients, 97 (94.17%) were pleased with the outcomes. CONCLUSION Liposuction and port site nipple sparing mastectomy are viable options for treating grade I to II gynecomastia, particularly if the patient prefers a more aesthetically pleasing chest contour; no scars equals better patient satisfaction. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- Mohamed Asal
- Alexandria University Faculty of Medicine, Alexandria, 21521, Egypt
| | - Moataz Ewedah
- Alexandria University Faculty of Medicine, Alexandria, 21521, Egypt
- Barking, Havering and Redbridge University Hospitals NHS Trust, Essex, UK
| | - Mahmoud Bassiony
- Alexandria University Faculty of Medicine, Alexandria, 21521, Egypt.
| | - Ahmed Abdelatif
- Alexandria University Faculty of Medicine, Alexandria, 21521, Egypt
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Burger A, Sattler A, Grünherz L, Giovanoli P, Lindenblatt N, Rieger UM. Scar versus shape: patient-reported outcome after different surgical approaches to gynecomastia measured by modified BREAST Q®. J Plast Surg Hand Surg 2023; 57:1-6. [PMID: 34591727 DOI: 10.1080/2000656x.2021.1981349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The challenge in the operative therapy for enlargement of the male breast is to deal with the skin excess. Shape and scars are the major parameters after which patients assess their operative result. Therefore, we assessed the satisfaction rate among patients undergoing subcutaneous mastectomy at our institution with special regard to scar tissue formation and the postoperative appearance of the chest wall in dependence of the surgical approach (periarolar versus inframammary fold). METHODS The study includes n = 36 male patients who underwent subcutaneous mastectomy at AGAPLESION Markus Hospital Frankfurt/Main. Patient's satisfaction dependent with the appearance of the chest wall and scar formation was evaluated by a modified BREAST Q® questionnaire plus two male-based additional questions. RESULTS There is no statistically significant difference in satisfaction with the operative result depending on the pattern of incision (periareolar versus submammary periareolar; 81.9% versus 75.5%) with the operative result. Evaluation of additional questions of the modified BREAST Q® questionnaire showed that 86% of the patients (n = 31) would rather have more scars and a flatter chest wall. A BMI >25 kg/m2 is accompanied by a higher risk for complications (p = 0.04). CONCLUSIONS Periareolar incision is still the method of choice, if promising an aesthetic appealing result. When reaching its limits though, we showed that a flat and male-shaped appearance of the chest wall is priority for the patients and should therefore be for the surgeon as well.
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Affiliation(s)
- Anna Burger
- Department of Plastic and Hand, Surgery University Hospital Zurich, Zurich, Switzerland
| | - Amelie Sattler
- Department of Traumatology and Orthopedics, Hospital of the Holy Ghost, Frankfurt, Germany
| | - Lisanne Grünherz
- Department of Plastic and Hand, Surgery University Hospital Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic and Hand, Surgery University Hospital Zurich, Zurich, Switzerland
| | - Nicole Lindenblatt
- Department of Plastic and Hand, Surgery University Hospital Zurich, Zurich, Switzerland
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Ramasamy K, Tripathee S, Murugesh A, Jesudass J, Sinha R, Alagarasan AR. A Single-Center Experience With Gynecomastia Treatment Using Liposuction, Complete Gland Removal, and Nipple Areola Complex Lifting Plaster Technique: A Review of 448 Patients. Aesthet Surg J Open Forum 2023; 5:ojac095. [PMID: 36866186 PMCID: PMC9972507 DOI: 10.1093/asjof/ojac095] [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: 01/03/2023] Open
Abstract
Background Gynecomastia is defined as a benign enlargement of male breast glandular tissue. It is the most common breast condition in male, and the prevalence ranges from 32% to 72%. No standardized treatment exists for gynecomastia. Objectives The authors treat gynecomastia patient with liposuction and complete gland excision through periareolar incision without skin excision. In case of skin redundancy, the authors use their special technique called nipple areola complex (NAC) plaster lift technique. Methods The authors conducted the retrospective analysis of patient who underwent gynecomastia surgery between January 2020 and December 2021 at Chennai Plastic Surgery. All patients were treated with liposuction, gland excision, and NAC lifting plaster when required. The follow-up period ranges from 6 to 14 months. Results A total of 448 patients (896 breasts) were included in our study with average age of 26.6 years. Grade II gynecomastia was most common in our study. The average BMI of the patients was 27.31 kg/m2. One hundred and sixteen patients (25.9%) experienced some form of complication. Seroma was most common complications in our study followed by superficial skin necrosis. Patient satisfaction rate was high in our study. Conclusions Gynecomastia surgery is safe and highly rewarding procedure for surgeons. Various technologies and methods like liposuction, complete gland excision, and NAC lifting plaster technique should be adopted in gynecomastia treatment to give a better patient satisfaction. Complications are common in gynecomastia surgery but easily manageable. Level of Evidence 4
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Affiliation(s)
- Karthik Ramasamy
- Corresponding Author: Dr Karthik Ramasamy, New No. 12, Old, 10, Mc Nichols Rd, 4th Lane, Chetpet, Chennai, Tamil Nadu 600031, India. E-mail:
| | | | | | | | - Rakesh Sinha
- Plastic surgeons in private practice in Chennai, India
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Liu C, Tong Y, Sun F, Zhang C, Yu Z, Yu P, Pan H, Zhou W, Shi J, Zhao Y. Endoscope-Assisted Minimally Invasive Surgery for the Treatment of Glandular Gynecomastia. Aesthetic Plast Surg 2022; 46:2655-2664. [PMID: 35237883 DOI: 10.1007/s00266-022-02807-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/27/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gynecomastia (GYN) is the most common benign disease in males. A vacuum-assisted biopsy is a minimally invasive surgical technique for GYN treatment that achieves satisfactory aesthetic results. However, due to the operation under non-direct vision, it is difficult to localize the bleeding points and assess the residual glandular tissue. Endoscopy was applied to observe the operative field after subcutaneous mastectomy. The present study aimed to recommend our initial experience in glandular GYN with endoscope-assisted minimally invasive subcutaneous mastectomy. METHODS A total of 34 patients diagnosed with glandular GYN (50 breasts), treated with endoscope-assisted minimally invasive surgery at The First Affiliated Hospital with Nanjing Medical University between June 2018 and June 2020, were enrolled in this study. According to Simon's classification of the breast, 10 was grade I, 25 was grade IIA, and 15 was grade IIB. The characteristics of patients, operative data, postoperative complications, cosmetic outcome, and patient satisfaction were recorded. RESULTS Endoscope-assisted minimally invasive mastectomy was performed successfully in all cases. The operative duration of the operation was 55-120 min/side. The total weight of the resected tissue of the 50 breasts was 55-350 g, and the blood loss was 10-105 mL/breast. Endoscopy detected five breasts with bleeding and three with residual glandular during the operation. Postoperative bleeding occurred in 1 breast, subcutaneous seroma in 3 breasts, dysesthesia of the nipple-areolar complex in 2 breasts, and skin redundancy in a bilateral patient. None of the patients experienced severe pain, infection, nipple necrosis, and nipple retraction, a saucer-like deformity. With a median follow-up of 21 months, all patients were satisfied with their cosmetic outcome (100%), and no recurrence occurred. CONCLUSION Endoscope-assisted minimally invasive mastectomy could be used as a feasible technique for the treatment of glandular GYN. 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)
- Congcong Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Ying Tong
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Feixiang Sun
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Chuanpeng Zhang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Ziyi Yu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Pan Yu
- Department of Plastic Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Hong Pan
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Wenbin Zhou
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jingping Shi
- Department of Plastic Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yi Zhao
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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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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Incidental Pathologic Findings in Young Men with Gynecomastia. Plast Reconstr Surg 2022; 149:608-613. [PMID: 35196673 DOI: 10.1097/prs.0000000000008815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pathologic examination of young adult gynecomastia tissue is controversial given the low incidence of breast carcinoma in this population. The authors examined the pathologic findings in a large cohort of adolescents with gynecomastia to evaluate the need for routine tissue analysis in this population. METHODS A retrospective review of men who underwent unilateral or bilateral mastectomy for gynecomastia at a single institution between February of 2007 and November of 2019 identified demographics, medical history, surgical characteristics, and pathologic findings. Descriptive statistics were performed. RESULTS A total of 268 male patients were included. Mean age was 16.6 years. Mean body mass index was 27.8 kg/m2, and 42.5 percent of the sample was obese. The majority (83.2 percent) underwent bilateral subcutaneous mastectomy. There were no abnormal histopathologic findings in 95.1 percent. Among the 13 patients with abnormalities, eight (3 percent) had nonproliferative changes, two (0.8 percent) had proliferative changes without atypia, two (0.8 percent) had atypical ductal hyperplasia, and one (0.4 percent) had both bilateral atypical ductal hyperplasia and unilateral ductal carcinoma in situ. No patients had invasive carcinoma. The three patients with atypical ductal hyperplasia and/or ductal carcinoma in situ were obese but had no other breast cancer or gynecomastia risk factors. CONCLUSIONS Findings conferring potentially increased risk of developing breast cancer were identified in three male adolescents (1.2 percent). Incidence of these findings is similar between male adolescents and similarly aged female adolescents undergoing breast reduction surgery. Although worrisome pathology results are rare, too little is known about the natural history of atypical proliferation and ductal carcinoma in situ in young men to recommend against routine analysis. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, IV.
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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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Approach to gynecomastia and pseudogynecomastia surgical techniques and its outcome: a systematic review. J Plast Reconstr Aesthet Surg 2022; 75:1704-1728. [DOI: 10.1016/j.bjps.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/17/2022] [Accepted: 02/12/2022] [Indexed: 11/17/2022]
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Ding N, Yu N, Dong R, Kong L, Xue H, Long X, Li Y, Wang Y, Huang X, Jin Z. Blood supply of the male breast nipple-areola complex evaluated by CTA. J Plast Reconstr Aesthet Surg 2021; 74:2588-2595. [PMID: 33879411 DOI: 10.1016/j.bjps.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/12/2021] [Accepted: 02/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE In addition to women, men also undergo breast surgeries, and early studies on the blood supply of breasts are nearly all conducted in female subjects. The vasculature of the male breast is seldom studied. Understanding the male-specific blood supply of the breast is important for pre-operative planning and reducing complications. The purpose of this retrospective study is to fill the gap in the literature by describing the main blood supply and its orientation in the male breast. METHODS We retrospectively evaluated thoracic computed tomographic angiography (CTA) data from January 1, 2017 to July 30, 2019. Single or multiple dominant arteries and their origins were traced, and the artery route and orientation related to the nipple-areola complex (NAC) were revealed through data analysis of the images. RESULTS Totally, 284 breasts were included. Most breasts were supplied by a single dominant artery (196, 69%), among which the lateral thoracic artery (LTA; 119, 41.9%; type I) and internal thoracic artery (ITA; 63, 22.2%; type II) were the most common arteries. A minority of breasts were supplied by vascular anastomoses formed by dual arteries (17, 6.0%; type III), and in 25.0% of breasts, no specific dominant artery was found (type IV). The predominant artery distribution was evaluated. CONCLUSION This study cohort of male thoracic CTA provided and analysed the elaborate vascular anatomy of the NAC region. Our results favour inferior periareolar incision in regard to diminished vascular-related complications in male surgeries without pre-operative vascular evaluation. This study also suggests that super-lateral or lower-lateral-based pedicles can reserve more vasculature.
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Affiliation(s)
- Ning Ding
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist., Beijing 100730, China
| | - Nanze Yu
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ruijia Dong
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lingyan Kong
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist., Beijing 100730, China.
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist., Beijing 100730, China
| | - Xiao Long
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yumei Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist., Beijing 100730, China
| | - Yun Wang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist., Beijing 100730, China
| | - Xin Huang
- Department of Breast Surgery, Peking Union Medical College Hospital Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist., Beijing 100730, China.
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Surgical Management of Gynecomastia: A Comprehensive Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3161. [PMID: 33173677 PMCID: PMC7647635 DOI: 10.1097/gox.0000000000003161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
Gynecomastia is a graded condition characterized by enlargement of the male breast that affects a significant proportion of the male population. A plethora of varying surgical approaches currently exists in the literature; thus this comprehensive review sought to analyze surgical practice patterns and trends as they pertain to gynecomastia grade and severity. The current literature was queried utilizing the PubMed and MEDLINE databases—based on predefined parameters and individual review, 17 studies were ultimately included. Key data points included gynecomastia grade, surgical intervention, rate of complication, including hematoma, seroma, infection, and necrosis, and drain use. Two-sample t test was utilized for further analysis. A total of 1112 patients underwent surgical treatment for gynecomastia. Skin-sparing mastectomy with or without liposuction was the most frequently used procedure followed by mastectomy with skin reduction. Major complication rates ranged from 0% to 33%, with hematoma formation being most common (5.8%) followed seroma (2.4%). There was a higher rate of hematoma/seroma formation among authors who routinely utilized drain placement (9.78% versus 8.36%; P = 0.0051); however, this is likely attributable to the large discrepancy in percentage of grade III patients found in each group (50.23% versus 4.36%; P = 0.0000). As a wide variety of surgical techniques exist for the treatment of gynecomastia, an individualized approach based upon gynecomastia grade and patient preference may assist the surgeon in providing optimal outcomes. This senior author’s preferred method for treatment of gynecomastia is illustrated in the included algorithm.
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Goldammer F, Bodin F, Bruant-Rodier C, Ruffenach L, Dissaux C. [Concomitant breast surgery with a vertical latero-thoracic incision in continuity with a brachioplasty incision: About twelve (12) cases after massive weight loss]. ANN CHIR PLAST ESTH 2020; 65:116-123. [PMID: 32169301 DOI: 10.1016/j.anplas.2020.01.005] [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: 12/28/2019] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The need of iterative surgeries, the proximity of two anatomical areas, the combination of an aesthetic surgery with a surgery covered by health insurance are the reasons which motivated the authors to provide a simultaneous procedure on arms and breast in patients achieving massive weight loss. We propose a vertical continuation of the lateral mastopexy incision superiorly, in continuity with a simultaneous brachioplasty incision to treat the excess skin and subcutaneous tissue of the lateral chest wall, either by resection, or by increasing the breast with the patients own autologous tissue. METHODS Between 2010 and 2017, twelve patients aged between 31 and 56 years, with 42 being the average, have undergone a technique that utilises a vertical continuation of the lateral mastopexy incision superiorly, in continuity with a simultaneous brachioplasty incision: transverse skin incisions and free nipple transplantation for correction of extreme gynaecomastia (2 cases), mastopexy with resection of the excess tissue of the lateral chest wall (8 cases), autologous breast augmentation by the use of intercostal artery perforator flaps (2 cases). Mean body mass index (BMI) was 24kg/m2 [23; 32] after average weight loss of 56kg [14; 112] following diet (3 cases) or bariatric surgery (9 cases). RESULTS Mean operative time was 4hours [3: 6], mean length of hospital stay was 4 days [2; 9]. We observed one major complication (hematoma) and one minor complication (wound dehiscence). At a mean follow-up of 21 months (ranged from 15 days to 84 months), the lateral flank scarring was well tolerated, with the additional benefit of reducing flank fullness. CONCLUSION The extended lateral flank scar allows reducing the excess skin and subcutaneous tissue of the lateral chest wall, while being easily concealable. This technique offers an elegant solution to this excess that used to persist after multistage surgeries.
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Affiliation(s)
- F Goldammer
- Service de chirurgie plastique esthétique et reconstructrice, centre hospitalo-universitaire de Strasbourg, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France.
| | - F Bodin
- Service de chirurgie plastique esthétique et reconstructrice, centre hospitalo-universitaire de Strasbourg, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
| | - C Bruant-Rodier
- Service de chirurgie plastique esthétique et reconstructrice, centre hospitalo-universitaire de Strasbourg, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
| | - L Ruffenach
- Service de chirurgie plastique esthétique et reconstructrice, centre hospitalo-universitaire de Strasbourg, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
| | - C Dissaux
- Service de chirurgie plastique esthétique et reconstructrice, centre hospitalo-universitaire de Strasbourg, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
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Abstract
BACKGROUND Pseudogynecomastia is the increased aggregation of fatty tissue in the area of the male breast with resultant female appearance. Two forms can appear: pseudogynecomastia after massive weight loss (pseudogynecomastia obese [PO]) and pseudogynecomastia, which is caused only by adipose tissue (pseudogynecomastia fat). For PO, only the Gusenoff classification with corresponding operative treatment options exists. However, this classification is limited by the fact that it underestimates the extensive variability of residual fat tissue and skin excess, both crucial factors for operative planning. For this reason, we propose a modification of the treatment algorithm for the Gusenoff classification based on our results to achieve more masculine results. MATERIALS AND METHODS A total of 43 male patients with PO were included in this retrospective study (grade 1a, n = 1; grade 1b, n = 1; grade 2, n = 17; grade 3, n = 24). Forty-two mastectomies with a free nipple-areola complex (NAC) transposition (grades 2 and 3) and 1 with a subcutaneous mastectomy (grade 1a) with periareolar lifting were performed. A retrospective chart review was performed to obtain data regarding age, body mass index, body mass index loss, weight loss, reason for weight loss, comorbidities, nicotine, and additional procedures, postoperative sensitive on the NAC transplants and complications. RESULTS None of the free-nipple grafts were lost. Forty (95%) of 42 patients with mastectomy had a resensitivity on the NAC. CONCLUSIONS For pseudogynecomastia, the treatment algorithm of the Gusenoff classification should be modified and adapted according to our recommendations to achieve more optimal masculine results.
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Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2316. [PMID: 31624695 PMCID: PMC6635198 DOI: 10.1097/gox.0000000000002316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 01/02/2023]
Abstract
Background: Mastectomy is a commonly requested procedure in the transmasculine population and has been shown to improve quality of life, although there is limited research on safety. The aim of this study was to provide a nationwide assessment of epidemiology and postoperative outcomes following masculinizing mastectomy and compare them with outcomes following mastectomy for cancer prophylaxis and gynecomastia correction in cisgender patients. Methods: The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2017 was queried using International Classification of Diseases and Current Procedural Terminology codes to create cohorts of mastectomies for 3 indications: transmasculine chest reconstruction, cancer risk-reduction (CRRM), and gynecomastia treatment (GM). Demographic characteristics, comorbidities, and postoperative complications were compared between the 3 cohorts. Multivariable regression analysis was used to control for confounders. Results: A total of 4,170 mastectomies were identified, of which 14.8% (n = 591) were transmasculine, 17.6% (n = 701) were CRRM, and 67.6% (n = 2,692) were GM. Plastic surgeons performed the majority of transmasculine cases (85.3%), compared with the general surgeons in the CRRM (97.9%) and GM (73.7%) cohorts. All-cause complication rates in the transmasculine, CRRM, and GM cohorts were 4.7%, 10.4%, and 3.7%, respectively. After controlling for confounding variables, transgender males were not at an increased risk for all-cause or wound complications. Multivariable regression identified BMI as a predictor of all-cause and wound complications. Conclusion: Mastectomy is a safe and efficacious procedure for treating gender dysphoria in the transgender male, with an acceptable and reassuring complication profile similar to that seen in cisgender patients who approximate either the natal sex characteristics or the new hormonal environment.
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3D Mammometric Changes in the Treatment of Idiopathic Gynecomastia. Aesthetic Plast Surg 2019; 43:616-624. [PMID: 30815735 DOI: 10.1007/s00266-019-01341-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Three-dimensional surface imaging (3DSI) has shown promise for plastic surgeons to objectively assess changes in body contour and breast volume. OBJECTIVES To assess the surgical outcome after bilateral subcutaneous mastectomy (BSM) and water jet-assisted liposuction (WAL) as treatment for idiopathic gynecomastia, using 3DSI to document changes regarding nipple-areolar complex (NAC) and breast volume. METHODS Thirty male patients (Simon II A to B) receiving BSM and WAL were enrolled. Eight subjects received additional mastopexy and NAC reduction. Use of a Vectra 3D Imaging System® before and 6 months after surgery provided data regarding changes of NAC placement and NAC and breast dimensions. The sum volume of intraoperatively approximated lipoaspirate before and after centrifugation and mastectomy specimens quantified using water displacement were compared with 3D-assessed differences in volume. RESULTS When compared to the NAC dimensions defined during surgery, patients receiving NAC reductions showed nonsignificant postoperative changes in NAC dimensions. Patients without additional mastopexy showed a significant (p < 0.001) vertical (15.7 ± 14.3%) and horizontal (17.1 ± 15.0%) reduction in NAC diameter. 3D volume changes (92.8 ± 26.4 mL) showed significant differences (p < 0.001) 6 months after surgery compared to the intraoperatively measured lipoaspirate before (182 ± 54.5 mL) and after (120 ± 34.6 mL) centrifugation. CONCLUSION Although it is clear that patient satisfaction must remain the prime focus of surgical body contouring, 3DSI has proven valuable to objectively demonstrate both the anticipated outcome and further findings regarding treatment of idiopathic 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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Discussion on "Gynecomastia Surgery-Impact on Life Quality: A prospective Case-Control Study". Ann Plast Surg 2018; 80:193-194. [PMID: 29319580 DOI: 10.1097/sap.0000000000001172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Do Adolescents with Gynecomastia Require Routine Evaluation by Endocrinology? Plast Reconstr Surg 2018; 142:9e-16e. [DOI: 10.1097/prs.0000000000004465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Fricke A, Lehner GM, Stark GB, Penna V. Gynecomastia: histological appearance in different age groups. J Plast Surg Hand Surg 2017; 52:166-171. [PMID: 28876176 DOI: 10.1080/2000656x.2017.1372291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Gynecomastia is a common finding in the male population which is mostly idiopathic. The aim of our study was to analyze the histological differences in young and old patient groups and its association with recurrence rates. METHODS Three hundred and five gynecomastia patients (555 breasts) undergoing surgical treatment from 1997 to 2015 were divided into four groups: Group 1: 13-17 years, Group 2: 18-30 years, Group 3: 31-49 years and Group 4: 50-83 years. They were evaluated concerning clinical classification, histological differences and association with antiandrogen or steroids/immunosuppressive therapy. RESULTS We found that the rate of florid gynecomastia was higher in older patient groups, while fibrous gynecomastia was more common in adolescents and young adults (p = .0180). Glandular gynecomastia was more frequent in younger patients, while in the older patient groups, lipomatous gynecomastia was more common (p = .0006). Patients presenting with florid gynecomastia showed a higher rate of recurrence than patients with the fibrous type of gynecomastia (12.5 and 4.7%, respectively). Of note, 18.75% of florid gynecomastia was associated with antiandrogen agents or steroid/immunosuppressive therapy, while only 4.69% of fibrous gynecomastia was associated with antiandrogenic or immunosuppressive therapy. However, there was no increase of recurrence rates in patients using antiandrogen agents or undergoing steroid/immunosuppressive therapy. CONCLUSIONS Fibrous gynecomastia was found to be more common in adolescents and young adults, while the florid type was more frequent in older patients. Patients presenting with florid gynecomastia showed a higher rate of recurrence than patients with the fibrous type of gynecomastia.
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Affiliation(s)
- Alba Fricke
- a Department of Plastic and Hand Surgery, Medical Center - Faculty of Medicine , University of Freiburg , Freiburg , Germany
| | - Gabriele M Lehner
- a Department of Plastic and Hand Surgery, Medical Center - Faculty of Medicine , University of Freiburg , Freiburg , Germany
| | - G Björn Stark
- a Department of Plastic and Hand Surgery, Medical Center - Faculty of Medicine , University of Freiburg , Freiburg , Germany
| | - Vincenzo Penna
- a Department of Plastic and Hand Surgery, Medical Center - Faculty of Medicine , University of Freiburg , Freiburg , Germany
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Chao JW, Raveendran JA, Maly C, Rogers G, Boyajian M, Oh AK. Closed-Suction Drains After Subcutaneous Mastectomy for Gynecomastia: Do They Reduce Complications? Aesthetic Plast Surg 2017; 41:1291-1294. [PMID: 28842781 DOI: 10.1007/s00266-017-0959-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND In cases of refractory gynecomastia, surgical excision of excess glandular breast tissue is often warranted. Closed-suction drain placement is commonplace; however, the effect of drains on preventing complications after male breast surgery has not been fully elucidated in the literature. OBJECTIVE To investigate the effect of drains on reducing seroma and hematoma after subcutaneous mastectomy for gynecomastia. METHODS Retrospective chart review of patients undergoing subcutaneous mastectomy for gynecomastia over a 10-year period. Charts were reviewed for demographics, BMI, comorbidities, type of local anesthesia, specimen weight, use of liposuction, and placement of drains. Outcomes were determined by seroma or hematoma in the 30-day postoperative period. RESULTS A total of 163 breasts were studied (group I = no-drain, n = 46; group II = drain, n = 117). Group I had a higher rate of clinically significant seromas requiring needle aspiration than group II (6.5 vs 0%, p = 0.0214). There was no difference in rates of hematoma (group I vs II, 2.2 vs 6.0%, p = 0.443) and total fluid collections (group I vs II, 19.6 vs 16.2%, p = 0.647). BMI, use of local anesthesia, specimen weight, and use of liposuction were not significantly associated with postoperative complications. CONCLUSIONS Closed-suction drains may reduce rates of clinically significant seromas requiring needle aspiration. Though drains carry their own pertinent adverse effects (e.g., patient discomfort and anxiety, cost, and additional clinic visits), there remains no universal standard of care and surgeon practices vary widely. Given the potential to reduce seroma rates, we recommend that surgeons consider placing drains and discuss with patients the benefits and risks of drains after surgical treatment of 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jerry W Chao
- Division of Plastic and Reconstructive Surgery, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA.
- School of Medicine and Health Sciences, The George Washington University, 2300 I Street NW, Washington, DC, 20052, USA.
| | - Janani A Raveendran
- School of Medicine and Health Sciences, The George Washington University, 2300 I Street NW, Washington, DC, 20052, USA
| | - Connor Maly
- School of Medicine, Georgetown University, 3900 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Gary Rogers
- Division of Plastic and Reconstructive Surgery, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA
| | - Michael Boyajian
- Division of Plastic and Reconstructive Surgery, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA
| | - Albert K Oh
- Division of Plastic and Reconstructive Surgery, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA
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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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Lee YK, Lee JH, Kang SY. Gynecomastia: glandular-liposculpture through a single transaxillary one hole incision. J Plast Surg Hand Surg 2017; 52:117-125. [DOI: 10.1080/2000656x.2017.1360318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yung Ki Lee
- Department of Plastic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jun Hee Lee
- Department of Plastic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Yoon Kang
- Department of Plastic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Özalp B, Berköz Ö, Aydınol M. Is the transposition of the nipple-areolar complex necessary in Simon grade 2b gynecomastia operations using suction-assisted liposuction? J Plast Surg Hand Surg 2017; 52:7-13. [PMID: 28471290 DOI: 10.1080/2000656x.2017.1313260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the efficacy of suction-assisted liposuction (SAL) in Simon grade 2b gynecomastia and its effect on sternal notch to nipple areola (SNN) distance. METHODS A retrospective analysis was performed on 21 patients with grade 2b gynecomastia who underwent SAL. Preoperative and postoperative SNN distances of the patients were measured, the results were analysed using a Mann-Whitney U test and a p-value <.05 was accepted as statistically significant. Aesthetic results were evaluated by the surgical team considering five criteria: breast size, breast shape, nipple-areolar complex positioning, scarring, and skin tightness of the breast envelope. A 10-point Likert scale was used to assess patient satisfaction with SAL surgery. RESULTS All of the patients were followed up for an average period of 17.8 months (range = 12-28 months). The mean amount of lipoaspirate was 232 mL per breast (range = 190-310 mL). The mean preoperative SNN distance was 22.3 cm (range = 20-23.5 cm), whereas postoperative was 21.3 cm (range = 19.2-22.8 cm); the difference was statistically significant (p < .05). There was one case of nipple areola necrosis, three hypoesthesia, five persistent pains, and four slight buttonhole deformities. The aesthetic result was evaluated as very good by the surgical team, and the overall patient satisfaction rate in terms of breast shape and volume was 92%. CONCLUSIONS It was concluded that SAL provides a good aesthetic outcome in patients with Simon grade 2b gynecomastia and shortens the SNN distance by 1 cm, but further clinical studies are required to support this conclusion.
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Affiliation(s)
- Burhan Özalp
- a Department of Plastic, Reconstructive and Aesthetic Surgery, Dicle Medical Faculty , Dicle University , Diyarbakır , Turkey
| | - Ömer Berköz
- b Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul Medical Faculty , Istanbul University , Istanbul , Turkey
| | - Mustafa Aydınol
- a Department of Plastic, Reconstructive and Aesthetic Surgery, Dicle Medical Faculty , Dicle University , Diyarbakır , Turkey
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El-Sabbagh AH. Combined approach for gynecomastia. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2016; 5:Doc10. [PMID: 26955509 PMCID: PMC4764784 DOI: 10.3205/iprs000089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Gynecomastia is a deformity of male chest. Treatment of gynecomastia varied from direct surgical excision to other techniques (mainly liposuction) to a combination of both. Skin excision is done according to the grade. In this study, experience of using liposuction adjuvant to surgical excision was described. Patients and methods: Between September 2012 and April 2015, a total of 14 patients were treated with liposuction and surgical excision through a periareolar incision. Preoperative evaluation was done in all cases to exclude any underlying cause of gynecomastia. Results: All fourteen patients were treated bilaterally (28 breast tissues). Their ages ranged between 13 and 33 years. Two patients were classified as grade I, and four as grade IIa, IIb or III, respectively. The first 3 patients showed seroma. Partial superficial epidermolysis of areola occurred in 2 cases. Superficial infection of incision occurred in one case and was treated conservatively. Conclusion: All grades of gynecomastia were managed by the same approach. Skin excision was added to a patient that had severe skin excess with limited activity and bad skin complexion. No cases required another setting or asked for 2nd opinion.
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Atiyeh BS, Chahine F, El-Khatib A, Janom H, Papazian N. Gynecomastia: Simultaneous Subcutaneous Mastectomy and Areolar Reduction with Minimal Inconspicuous Scarring. Aesthetic Plast Surg 2015; 39:916-21. [PMID: 26446418 DOI: 10.1007/s00266-015-0567-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
Abstract
Acceptable scar positioning on the anterior male chest is very limited. In Gynecomastia surgery, an obvious areolar incision is the most sensitive indicator of a previous operation; a less apparent scar is indispensable for the patient's psychological satisfaction. Whenever only areolar diameter reduction is required, the circumareolar incision must be performed in a position leaving the least conspicuous scar. Standard excision of an outer doughnut of areolar skin results in a visible and unnatural peri-areolar scar. The peri-nipple excision of areolar skin leaves the skin-areola junction undisturbed. When combined with a transverse areolar infra-nipple incision, access for subcutaneous mastectomy is facilitated. With this approach, risk of nipple vascular compromise is thought to be reduced, and necrosis of areolar pigmented skin virtually impossible. EBM LEVEL V 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)
- Bishara S Atiyeh
- Division of Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Fadel Chahine
- Division of Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Arij El-Khatib
- Division of Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hamed Janom
- Division of Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nazareth Papazian
- Division of Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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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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Gynecomastia surgery is associated with improved nipple location in young korean patients. Arch Plast Surg 2014; 41:748-52. [PMID: 25396190 PMCID: PMC4228220 DOI: 10.5999/aps.2014.41.6.748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/31/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022] Open
Abstract
Background Gynecomastia is benign enlargement of breast tissue in males and is fairly common. Mastectomy not only helps in improving the shape of anterior chest, but can also improve the location of nipple. Therefore, a principle element of mastectomy design is defining the normal location of nipple based on major anatomical reference points. Here, the nipple location was compared for before and after gynecomastia surgery. In addition, the same was also compared between male patients undergoing gynecomastia surgery and control group of subjects without gynecomastia. Methods We retrospectively analyzed gynecomastia patients who underwent conventional subcutaneous mastectomy. Preoperative and postoperative anatomical landmark distances and chest circumferences were measured and compared to the same anthropometric data from 20 healthy adult male controls. Results Nipple locations were compared among 13 patients and 20 controls. The mean weight of resected breast tissue was 246 g, and overall patient satisfaction grade was 4.3 out of 5. In the patient group, the slopes for the height-distance from the sternal notch to the nipple and chest circumference-distance between the mid-line of the sternum and the nipple were 0.175 and 0.125 postoperatively, respectively. The slopes of the control group were 0.122 and 0.177, respectively; these differences were statistically significant (P<0.05). Conclusions Nipple positions were considerably lower in patients with gynecomastia than in control subjects. Subcutaneous mastectomy was associated with mild elevations, but postoperative locations were still lower compared to controls. Further efforts are needed to improve the location of postoperative nipple-areola complex in patients with gynecomastia.
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Abstract
Gynaecomastia (enlargement of the male breast tissue) is a common finding in the general population. Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance. However, the condition might cause local pain and tenderness, could occasionally be the result of a serious underlying illness or a medication, or be inherited. Breast cancer in men is much less common than benign gynaecomastia, and the two conditions can usually be distinguished by a careful physical examination. Estrogens are known to stimulate the growth of breast tissue, whereas androgens inhibit it; most cases of gynaecomastia result from deficient androgen action or excessive estrogen action in the breast tissue. In some cases, such as pubertal gynaecomastia, the breast enlargement resolves spontaneously. In other situations, more active treatment might be required to correct an underlying condition (such as hyperthyroidism or a benign Leydig cell tumour of the testis) or medications that could cause breast enlargement (such as spironolactone) might need to be discontinued. For men with hypogonadism, administration of androgens might be helpful, as might antiestrogen therapy in men with endogenous overproduction of estrogens. Surgery to remove the enlarged breast tissue might be necessary when gynaecomastia does not resolve spontaneously or with medical therapy.
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Affiliation(s)
- Harmeet S Narula
- Medical Service, Veterans Affairs Medical Center, 6900 Pecos Road, North Las Vegas, NV 89086, USA
| | - Harold E Carlson
- Department of Medicine, Endocrinology Division, Stony Brook University School of Medicine, HSC T15-060, Stony Brook, NY 11794-8154, USA
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Tabbed tissue expanders improve breast symmetry scores in breast reconstruction. Arch Plast Surg 2014; 41:57-62. [PMID: 24511496 PMCID: PMC3915158 DOI: 10.5999/aps.2014.41.1.57] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/07/2013] [Accepted: 08/08/2013] [Indexed: 12/30/2022] Open
Abstract
Background Achieving symmetry is a key goal in breast reconstruction. Anatomically shaped tabbed expanders are a new tool in the armamentarium of the breast reconstruction surgeon. Suture tabs allow for full control over the expander position and thus inframammary fold position, and, in theory, tabbed expanders mitigate many factors responsible for poor symmetry. The impact of a tabbed expander on breast symmetry, however, has not been formally reported. This study aims to evaluate breast symmetry following expander-implant reconstruction using tabbed and non-tabbed tissue expanders. Methods A chart review was performed of 188 consecutive expander-implant reconstructions that met the inclusion criteria of adequate follow-up data and postoperative photographs. Demographic, oncologic, postoperative complication, and photographic data was obtained for each patient. The photographic data was scored using a 4-point scale assessing breast symmetry by three blinded, independent reviewers. Results Of the 188 patients, 74 underwent reconstruction with tabbed expanders and 114 with non-tabbed expanders. The tabbed cohort had significantly higher symmetry scores than the non-tabbed cohort (2.82/4±0.86 vs. 2.55/4±0.92, P=0.034). Conclusions The use of tabbed tissue expanders improves breast symmetry in tissue expander-implant-based breast reconstruction. Fixation of the expander to the chest wall allows for more precise control over its location and counteracts the day-to-day translational forces that may influence the shape and location of the expander pocket, mitigating many factors responsible for breast asymmetry.
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Management of prepubertal gynecomastia in two monozygotic twins with Peutz-Jeghers syndrome: from aromatase inhibitors to subcutaneous mastectomy. Aesthetic Plast Surg 2013; 37:1012-22. [PMID: 23860822 DOI: 10.1007/s00266-013-0188-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 06/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Prepubertal gynecomastia is characterized by the presence of palpable uni- or bilateral breast tissue in boys without other signs of sexual maturation. It may be the endocrine expression of rare syndromes such as Peutz-Jeghers syndrome (PJS). This study aimed to evaluate the effectiveness of anastrozole and to describe an innovative surgical approach. METHODS This report presents twins with PJS, bilateral prepubertal gynecomastia, and testicular multifocal calcifications. Both twins were treated with anastrozole for 2 years. After finishing treatment, both were followed before subcutaneous mastectomy was performed by the "modified" Webster technique. RESULTS Growth velocity decreased and gynecomastia diminished during anastrozole treatment. After discontinuation of therapy due to a sharp reduction in growth velocity, both twins showed regrowth of gynecomastia, with painful and strained breasts. A significant reduction in breast volume with glandular removal was achieved. CONCLUSIONS The findings of this study showed a multidisciplinary approach to prepubertal gynecomastia due to the synergy of pediatricians, radiologists, and plastic surgeons. The follow-up evaluation after the anastrozole treatment showed it to be an efficacious medical treatment, as an alternative to orchidectomy, to control the effects of circulating estrogens. Moreover, the results observed in the patients confirmed the validity and feasibility of the "modified" Webster technique in terms of aesthetic and functional results, patient satisfaction, and absence of complications.
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