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Metwalley KA, Farghaly HS. Gynecomastia in adolescent males: current understanding of its etiology, pathophysiology, diagnosis, and treatment. Ann Pediatr Endocrinol Metab 2024; 29:75-81. [PMID: 38712491 PMCID: PMC11076233 DOI: 10.6065/apem.2346142.071] [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] [Received: 07/15/2023] [Revised: 08/23/2023] [Accepted: 10/04/2023] [Indexed: 05/08/2024] Open
Abstract
Gynecomastia (GM) is a common and continuously evolving condition that commonly occurs during adolescence. It is the source of significant embarrassment and psychological stress in adolescent males. GM is characterized by enlargement of the male breast due to the proliferation of glandular ducts and stromal components. The main cause of GM during adolescence is physiological or pubertal GM, which is primarily attributed to an imbalance between estrogen and androgen activity. Physiological GM is typically transient and resolves within several months, although it may take several years to resolve. GM may also be caused by other pathological conditions and could be indicative of an endocrine disease. It is crucial to understand the pathogenesis of GM to distinguish it from normal developmental variants due to pathological causes. The aim of this review is to highlight the significance of GM during adolescence in terms of potential etiologies, clinical and laboratory diagnoses, and current management.
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Affiliation(s)
| | - Hekma Saad Farghaly
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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Saoud S, Arreyouchi D, Ankiz A, Haloui A, Karich N, Bennani A, Oufkir AA. Pseudoangiomatous stromal hyperplasia: a rare cause of gynecomastia in men. Case Reports Plast Surg Hand Surg 2024; 11:2303993. [PMID: 38250333 PMCID: PMC10798276 DOI: 10.1080/23320885.2024.2303993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
A 17-year-old male with chest malformation and left breast enlargement underwent surgery for gynecomastia. Histological examination revealed mammary fibrous stroma with ductal hyperplasia and features of pseudoangiomatous stromal hyperplasia. Postoperative follow-up showed no complications, but 8 months later, the patient experienced a mild recurrence with enlargement of the nipple-areolar complex. Although recommended for secondary glandular resection, the patient declined further surgery.
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Affiliation(s)
- Sarah Saoud
- Department of Burns and reconstructive Surgery, Mohamed 6 hospital, Oujda Research Laboratory in Medical Sciences, Faculty of Medicine and Pharmacy of Oujda, Mohamed First University, Oujda, Morocco
| | - Doha Arreyouchi
- Department of Burns and reconstructive Surgery, Mohamed 6 hospital, Oujda Research Laboratory in Medical Sciences, Faculty of Medicine and Pharmacy of Oujda, Mohamed First University, Oujda, Morocco
| | - Anas Ankiz
- Department of Burns and reconstructive Surgery, Mohamed 6 hospital, Oujda Research Laboratory in Medical Sciences, Faculty of Medicine and Pharmacy of Oujda, Mohamed First University, Oujda, Morocco
| | - Anass Haloui
- Department of Pathology, Central Laboratory, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed Premier, Oujda, Morocco
| | - Nassira Karich
- Department of Pathology, Central Laboratory, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed Premier, Oujda, Morocco
| | - Amal Bennani
- Department of Pathology, Central Laboratory, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed Premier, Oujda, Morocco
| | - Ayat Allah Oufkir
- Department of Burns and reconstructive Surgery, Mohamed 6 hospital, Oujda Research Laboratory in Medical Sciences, Faculty of Medicine and Pharmacy of Oujda, Mohamed First University, Oujda, Morocco
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Beniwal M, Singh K, Singh P, Sharma A, Beniwal S. The Burden of Anabolic Androgenic Steroid-Induced Gynecomastia. Indian J Plast Surg 2023; 56:338-343. [PMID: 37705825 PMCID: PMC10497340 DOI: 10.1055/s-0043-1771293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Introduction Gynecomastia is benign proliferation of male breast tissue that can be idiopathic or secondary to hormonal imbalance. Consumption of steroids plays a major role in the development of gynecomastia. The increased consumption of anabolic androgenic steroid (AAS) in youngsters to boost the physical strength and improve appearance is associated with increased prevalence of gynecomastia. True estimation of AAS-associated gynecomastia is difficult to calculate and prone to underestimation because of low social acceptance. Accurate estimation is required to assess future healthcare, for prevention and to give appropriate treatment. Aims and Objectives The aim of this study was to calculate the steroid consumption in gynecomastia patients accurately so that appropriate treatment can be given and their response to treatment could be analysed. Methods This is a prospective study done in a tertiary care hospital from June 2019 to June 2022. All the gynecomastia patients treated during this period in Burns & Plastic Surgery Department of PGIMS Rohtak were included in the study. Patient's detailed history was recorded and also after 3 months of surgery patients were again enquired about their history to record any change. Results Real prevalence of AAS-associated gynecomastia (39.19%) was much higher than that recorded in preoperative period (4.05%). Also, AAS users were having higher body mass index and a greater proportion of patients were bodybuilders. Conclusion Patients with high body mass index, athletic body, and history of recent weight gain should raise the suspicion of anabolic steroid intake. Surgery is not always indicated in AAS-associated gynecomastia. If gynecomastia persisted, surgery necessitates and it involves meticulous intraoperative hemostasis and careful glandular excision to minimize recurrence and achieve low complication rates.
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Affiliation(s)
- Meenu Beniwal
- Department of Burns & Plastic Surgery, PGIMS Rohtak, Haryana, India
| | - Kuldeep Singh
- Department of Burns & Plastic Surgery, PGIMS Rohtak, Haryana, India
| | | | - Abhishek Sharma
- Department of Burns & Plastic Surgery, PGIMS Rohtak, Haryana, India
| | - Sonu Beniwal
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
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Sreelesh L, Rajan S, Anu AK. Etiopathological Factors Associated with Gynecomastia Patients Seeking Surgical Correction in the South Indian Population. Indian J Plast Surg 2022; 55:364-367. [PMID: 36683888 PMCID: PMC9859683 DOI: 10.1055/s-0042-1759498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Although several medical conditions are associated with gynecomastia, around 60% of cases are idiopathic. The role of endocrine testing in idiopathic gynecomastia is controversial. This study was done to determine the etiological and lifestyle factors associated with different grades of gynecomastia. Patients and Methods This was a descriptive study conducted at the department of plastic surgery in a tertiary care hospital in South India between January 2014 and December 2016, among the patients seeking corrective surgery for gynecomastia. Results A total of 73 patients were included in the study with a mean age of 22.56 years. The majority of the patients displayed Simon's Grade IIa gynecomastia (56.2%). The etiological factors identified in this study were hormonal abnormalities (47.95%), hypogonadism (2.7%), and drug intake (1.4%). The most common hormonal abnormality discovered was high estradiol values (15.1%) followed by decreased testosterone levels (13.7%). The chi-squared test revealed no statistically significant relationship between the hormonal values, type of food, body mass index (BMI), or physical activity and the grades of gynecomastia. Conclusion Most of the patients (50.68%) in our study had idiopathic gynecomastia. The most common hormonal abnormality detected was high estradiol values. No correlation was found between the hormonal values, type of food, BMI, or physical activity and the grades of gynecomastia.
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Affiliation(s)
- L.S. Sreelesh
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala, India,Address for correspondence L.S Sreelesh, MS, MCh, DNB “Thaara,”Nanminda. P.O, Kozhikode 673613, KeralaIndia
| | - Sheeja Rajan
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala, India
| | - A. K. Anu
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala, 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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Prasad P, Bennett A, Speirs V, Shaaban AM. Morphological Features and Immunohistochemical Profiling of Male Breast Gynaecomastia; A Large Tissue Microarray Study. Front Oncol 2022; 12:875839. [PMID: 35814372 PMCID: PMC9261459 DOI: 10.3389/fonc.2022.875839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Gynaecomastia is the commonest male breast condition accounting for approximately 85% of male breast lesions. There is minimal information on the immunohistochemical profile of gynaecomastia. We aimed to comprehensively profile a large series of gynaecomastia samples for putative mammary diagnostic, predictive and prognostic markers. Methods A total of 156 samples, were histologically reviewed, assembled onto tissue microarrays, and stained for oestrogen receptors (ERα, ERβ1, ERß2), progesterone receptors (total PR, PRα), androgen receptor (AR), basal & luminal cytokeratins (CK5/6, CK14, CK8/18) and the proliferation marker Ki67. Relevant cut offs for marker positivity were defined based on existing literature: AR (10%), ERα and PR (Allred score >3/8), ERß (10% and 20%), cytokeratins (10%) and Ki67 (10% and 20%). Results 108 samples from 86 patients aged 13-75 years were available for immunohistochemical assessment. 73.1% of the lesions were AR positive, compared to 99% for ERα and 100% for both ERß1 and ERß2. 98% of samples were positive for total PR and 97.1% for PRα. 69.8% expressed CK5/6 whilst 57% were CK14 positive. A tri-layered pattern of cytokeratin expression was also observed. Ki67 positivity was low with 17.1% and 6.7% classified as Ki67 positive using 10% and 20% cut off values respectively. A significant negative correlation was found between ERα expression and patient age (rs = -0.221, p=0.023). Bivariate correlations were produced, and comparisons made with previously published data regarding the immunohistochemical status in normal female breast tissue, proliferative and neoplastic breast diseases of the female and male breast. Conclusions Hormone receptors, including oestrogen receptor α and ß isoforms as well as androgen receptors were abundantly expressed within the intraductal luminal hyperplastic epithelium in gynaecomastia supporting the hormonal role in the pathogenesis and treatment. ERα, ERβ1 and ERβ2 were expressed in a higher proportion of cells compared with their expression in the female breast benign lesions which further characterises gynaecomastia biology. The identification of a low Ki67 proliferative index and the mixed cytokeratin profile in gynaecomastia differentiates this benign condition from male breast cancer. Therefore, Ki67 and cytokeratins can help in the differential diagnosis from histological mimics in the routine diagnostic work up.
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Affiliation(s)
- Prakruthi Prasad
- School of Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Aneliese Bennett
- Cellular Pathology, Mid Yorkshire Hospital National Health Service (NHS) Trust, Dewsbury, United Kingdom
| | - Val Speirs
- School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Abeer M. Shaaban
- Queen Elizabeth Hospital Birmingham and Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Abeer M. Shaaban,
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Safety, Efficacy, and Tolerability of Simultaneous Bilateral Cryolipolysis Using a Rapid Cycling Contoured Cup Applicator for Noninvasive Fat Reduction in the Enlarged Male Breast: A Pilot Study. Dermatol Surg 2022; 48:642-647. [PMID: 35363633 DOI: 10.1097/dss.0000000000003443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A previous study using a parallel cooling plate cryolipolysis applicator demonstrated the efficacy of cryolipolysis for pseudogynecomastia. Although the procedure was safe and effective, treatment times were prolonged and anesthetic was needed to reduce treatment discomfort. OBJECTIVE To evaluate the safety, efficacy, and tolerability of a short cycle, reduced vacuum contoured cup cryolipolysis applicator for the treatment of pseudogynecomastia. MATERIALS AND METHODS Twelve male subjects received simultaneous bilateral treatment consisting of a 35-minute cryolipolysis cycle, followed by a short manual massage, and a second 35-minute cycle with 50% treatment area overlap in a single treatment visit. At the 6-week follow-up, a second treatment was performed with up to 2 overlapping cycles per side. Efficacy was assessed after the second treatment using transcutaneous ultrasound, standardized clinical photography, and subject surveys. RESULTS Ultrasound analysis showed a mean fat layer reduction of 5.1 ± 2.3 mm (p < .001). Blinded, independent reviewers correctly identified 97% of baseline/treatment photography results. Surveys revealed 100% subject satisfaction with 91% reporting visible fat reduction and 100% stating they would recommend treatment. Transient side effects included mild intratreatment discomfort, paresthesia, and tenderness. CONCLUSION A rapid cycling, reduced vacuum cryolipolysis applicator provides rapid, safe, effective, and tolerable treatment of pseudogynecomastia.
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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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Pistolese CA, Perretta T, Claroni G, Anemona L, Servadei F, Collura A, Censi M, Materazzo M, Pellicciaro M, Lamacchia F, Vanni G. A Prospective Evaluation of Tru-Cut Biopsy and Fine-needle Aspiration Cytology in Male Breast Cancer Detection. In Vivo 2021; 34:3431-3439. [PMID: 33144451 DOI: 10.21873/invivo.12182] [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: 06/22/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Male breast-cancer (MBC) is often diagnosed late. Our purpose was to evaluate fine-needle aspiration cytology (FNAC) versus Tru-Cut biopsy (TCNB) in MBC diagnosis. PATIENTS AND METHODS Men with suspicious breast lesions were prospectively enrolled; 54 met the inclusion criteria and underwent FNAC and TCNB. FNAC, TCNB and gold-standard results were compared. RESULTS Unsatisfactory results were 11.1% after FNAC and none after TCNB (p=0.027). After gold-standard evaluation, the diagnosis of FNAC and TCNB was confirmed, respectively, in 63.0% and 98.1% and changed in 37.0% and 1.9% (p<0.001). The malignancy rate after FNAC, TCNB and surgery were, respectively, 25.9%, 33.3% and 35.1% (FNAC vs. TCNB p=0.5276, FNAC vs. surgery p=0.404; TCNB vs. surgery p=1). Among invasive carcinomas, 93.8% were identified by FNAC vs. 87.5% by TCNB (p=1); all ductal carcinoma in situ (DCIS) were detected after TCNB and none after FNAC (p=0.1). CONCLUSION FNAC leads to a significantly higher number of inadequate samplings and seems to be subject to increased DCIS misdiagnoses. TCNB correlated better to the final histological report.
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Affiliation(s)
- Chiara Adriana Pistolese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Tommaso Perretta
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Giulia Claroni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Alberto Collura
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Michela Censi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Materazzo
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
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Billa E, Kanakis GA, Goulis DG. Imaging in gynecomastia. Andrology 2021; 9:1444-1456. [PMID: 34033252 DOI: 10.1111/andr.13051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gynecomastia (GM) is the benign proliferation of glandular tissue in the male breast. It is a common condition, which may occur physiologically and shows three age peaks during a male's lifespan: infancy, puberty, and senescence. An underlying pathology may be revealed in 45%-50% of adult men with GM, such as aggravating medications, systemic diseases, obesity, endocrinopathies, or malignancy. OBJECTIVE To discuss the role of imaging in the evaluation of GM and its contribution to therapeutic decision-making. MATERIALS/METHODS The current literature was reviewed through PubMed, Scopus, and CENTRAL electronic databases to identify the best available evidence concerning imaging modalities in patients with GM. RESULTS Most male breast lesions can be diagnosed on clinical grounds; however, in certain cases, when physical examination is inconclusive, imaging may be helpful. DISCUSSION The main purpose of evaluating a patient with GM is to establish the diagnosis and differentiate true GM from pseudogynecomastia, exclude breast cancer, and detect the possible cause. GM is seen in mammography as a subareolar opacity and three mammographic patterns of GM are described: nodular, dendritic, and diffuse, corresponding to florid GM of early onset, fibrous persistent GM, and GM due to exogenous estrogen administration, respectively. In ultrasound (US), florid GM is depicted as a disk-shaped, hypoechoic area underlying the areola, whereas echogenicity of the lesions increases as fibrosis develops. Data on the use of MRI in the evaluation of the male breast and GM are still limited. Imaging findings can be classified according to the BIRADS (breast imaging reporting and data system) based on their malignant potential. CONCLUSION Both mammography and US are sensitive and specific to diagnose GM and distinguish it from breast cancer. When clinical findings are suggestive of malignancy or imaging findings are inconclusive, a histological confirmation should be sought.
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Affiliation(s)
- Evangelia Billa
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George A Kanakis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Endocrinology, Athens Naval and Veteran Affairs Hospital, Athens, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy. J Plast Reconstr Aesthet Surg 2021; 74:3128-3140. [PMID: 34001449 DOI: 10.1016/j.bjps.2021.03.098] [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: 05/22/2020] [Revised: 01/09/2021] [Accepted: 03/13/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons; the present study investigates the role of radiation therapy in this context. METHODS A systematic review was performed to evaluate the utility of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. RESULTS Fifteen articles met the inclusion criteria for review. The mean incidence of gynecomastia was 70% in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Radiotherapy was shown to significantly reduce the incidence to a median of 23%, with all six randomized control studies assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. The median complication rate was 12.4% with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. While the efficacy of radiation therapy as a treatment modality for gynecomastia was also established, it was shown to be less effective than other available options. CONCLUSIONS Low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients; further studies are indicated within the common gynecomastia population managed by plastic surgeons to assess the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients.
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Yang Y, Mu D, Xu B, Li W, Zhang X, Lin Y, Li H. Endoscopic subcutaneous mastectomy plus liposuction via a single axillary incision for gynecomastia in Asian patients: A report of 45 cases. Surgery 2021; 170:39-46. [PMID: 33715850 DOI: 10.1016/j.surg.2021.01.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most techniques for surgical correction of gynecomastia are performed by anterior and/or lateral chest incisions, showing an "operated" appearance. Our initial experience was introduced in gynecomastia with a combination of endoscopic subcutaneous mastectomy and liposuction via an axillary single incision. METHODS Between September 2018 and July 2019, a series of 45 male patients who had Simon grade I or II gynecomastia were enrolled in this study. The demographics, operative data, and postoperative complications were recorded in detail. Four independent observers gave their ratings by assigning scores of 1 to 5 for 6 main aesthetic aspects based on pre and postoperative photographs. RESULTS Endoscopic subcutaneous mastectomy combined with liposuction via an axillary single incision was performed successfully in all cases. Mean operative duration was 82.6 minutes for each side (37.5-132.5 minutes). The weight of the resected glandular tissue of the 89 breasts was 26 to 130 g and the aspiration volume was 60 to 700 mL. Three unilateral subcutaneous seromas (3.3%), 5 unilateral hematomas (5.6%), and 1 bilateral minimal skin redundancy (2.2%) were encountered. Observer-reported outcomes indicated that patients with grade Ⅰ gynecomastia had significantly better aesthetic results than those with grade Ⅱb in the aspects of symmetry, shape of nipple, shape of areola, contour regularity, and overall appearance (P < .001). Patients with grade Ⅱa gynecomastia also witnessed better improvement than grade Ⅱb in shape of nipple, contour regularity, and overall appearance (P < .05). CONCLUSION Endoscopic subcutaneous mastectomy combined with liposuction via an axillary single incision is a feasible minimally invasive technique for the treatment of gynecomastia. The combined method is effective in achieving satisfied aesthetic results for Simon grades I and Ⅱa gynecomastia, and it can also be an alternative choice for grade Ⅱb.
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Affiliation(s)
- Yan Yang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Dali Mu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
| | - Boyang Xu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Wandi Li
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiaoyu Zhang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yan Lin
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Haoran Li
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Acharya SV. Clinical features, presentation and hormonal parameters in patients with pubertal gynecomastia. J Family Med Prim Care 2021; 10:648-651. [PMID: 34041055 PMCID: PMC8138374 DOI: 10.4103/jfmpc.jfmpc_1987_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/02/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
Objective: Gynecomastia is benign enlargement of breast in male. It is postulated that its development is primarily due to a mismatch in ratio of oestrogen and androgen at breast tissue. The aim of this study was to highlight the clinical features, presentation and hormonal parameters at the time of consultation. Methods: All adolescent patients who attended endocrinology department with the complaint of breast enlargement were taken into study. We analysed their thyroid function test, oestrogen, testosterone, prolactin, alpha-fetoprotein, follicle-stimulating hormone, luteinizing hormone, beta HCG (human chorionic gonadotropin) and liver function. Clinical features and anthropometry were recorded. Results: Out of 50 patients enrolled, 34 (68%) had bilateral gynaecomastia while 16 patients (32%) had unilateral disease. Mastalgia was seen in 44 patients (88%). Psychological disturbance in the form of depression was seen in 60% of adolescent boys with gynecomastia. Tanner stage B had positive correlation with oestrogen to testosterone (E2/TTE) ratio (r = 0.47; P = 0.034). All other hormonal parameters were normal. Conclusion: Mastalgia was one of the presenting complaints in majority of patients and many had bilateral enlargement. Altered oestrogen to testosterone ratio is altered in majority of patients thus may be reason for pubertal gynecomastia.
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Affiliation(s)
- Shrikrishna V Acharya
- Consultant Endocrinologist K S Hegde Medical Academy Nitte University Mangalore, Karnataka, India
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Raheem AA, Zaghloul AS, Sadek AMG, Rayes B, Abdel-Raheem TM. The Impact and Management of Gynaecomastia in Klinefelter Syndrome. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:629673. [PMID: 36303983 PMCID: PMC9580767 DOI: 10.3389/frph.2021.629673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/15/2021] [Indexed: 11/21/2022] Open
Abstract
Gynecomastia is defined as a palpable enlargement of the male breast, secondary to an increase in the glandular and stromal breast tissue. Gynecomastia is encountered in up to 80% of Klinefelter syndrome cases. The pathophysiology involves testosterone/estrogen imbalance. This review article will further explore the pathophysiology of gynecomastia along with the different lines of management.
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Affiliation(s)
- Amr Abdel Raheem
- Andrology Department Cairo University Hospital, Beni Suef, Egypt
- Faculty of Population Health Sciences, Institute for Women's Health, University College London, London, United Kingdom
- *Correspondence: Amr Abdel Raheem
| | | | | | - Bilal Rayes
- King's College London, London, United Kingdom
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Abstract
PURPOSE OF REVIEW We aim to conduct a systematic review of the literature, document all reported cases of breast cancer development in cis men and female-to-male (FtM) transgender men undergoing testosterone replacement therapy (TRT), and determine if testosterone poses a substantial risk of breast cancer development and recurrence. RECENT FINDINGS A systematic search through December 2019 was performed. Out of 1890, 15 studies were eligible for inclusion in the final analyses. In total, 22 patients have developed breast cancer while on testosterone treatment. Four cases were cis men, whereas 18 cases were FtM. Age ranged from 18 to 61 years. Testosterone treatment duration ranged from 5 weeks up to 25 years. SUMMARY There is a relatively higher incidence of BCa in FtM on CSH therapy compared with cis men on TRT. Because of the small sample size of reported cases, we cannot delineate the exact relationship between testosterone therapy and BCa development. Additionally, we have limited data to suggest that TRT should or should not be contraindicated in cis men and FtM with a prior history of breast cancer.
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Endoscopic Axillary Approach Improves Patient Satisfaction of Gynecomastia Subcutaneous Mastectomy: A Cross-Sectional Study Using the BODY-Q Chest Module. Aesthetic Plast Surg 2020; 44:2011-2020. [PMID: 31555872 DOI: 10.1007/s00266-019-01501-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gynecomastia is a common condition that refers to the benign enlargement of male breasts. Several minimally invasive techniques were invented to avoid visible scars in the chest area, but have limited effects on the dense fibroglandular breast tissue, and open excision remains the mainstay of treatment. Endoscopic subcutaneous mastectomy has the superiority of visualization, facilitating accurate dissection and hemostasis, also enabling inconspicuous scars. This study was designed to evaluate the patient-reported outcomes of the endoscopic axillary approach in treating gynecomastia, to interpret the differences between it and the conventional periareolar open excision method, and to present our experience utilizing this technique as a reliable alternative for Simon I and II gynecomastia. METHODS Eighty-three participants diagnosed with Simon I or II gynecomastia were included in this cross-sectional study, among which 31 were preoperative and 52 were postoperative patients. Postoperative participants were divided into two groups according to whether endoscopic axillary subcutaneous mastectomy (axillary group, n = 25) or periareolar open excision (periareolar group, n = 27) was performed. Patient-reported outcomes were assessed using the BODY-Q questionnaire, including the chest, nipples, body image, social, appearance-related distress, and scar domain, with scores ranging from 0 to 100. RESULTS The BODY-Q score of both axillary and periareolar postoperative groups showed significant improvement on chest (p < 0.001), nipples (p < 0.001), body image (p < 0.001), and appearance-related distress (p < 0.005) scales, compared with the preoperative group. Of the scar scale, the axillary group rated higher scores than the periareolar group (p = 0.019), analysis of the individual scale items showed more positive responses in questions "Location of your scars?" (p < 0.001) and "How your scars look when they are not covered by clothes?" (p < 0.001), the item "Having to dress in a way to hide your scars?" also had a somewhat more positive responses from participants (p = 0.095). CONCLUSIONS The present findings indicate that compared with the periareolar excision, patients who underwent gynecomastia subcutaneous mastectomy through endoscopic axillary approach have higher scar satisfaction with postoperative outcomes, this probably because of the well-hidden scar at the axilla, which leverages the psychologic burden of the patient after surgery. Future prospective studies are needed to measure changes over the entire patient journey, to find out the predictable factors of postoperative patient satisfaction, and determine how the objective outcomes relate to changes in patient's health-related quality of life. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Lorek M, Tobolska-Lorek D, Kalina-Faska B, Januszek-Trzciakowska A, Gawlik A. Clinical and Biochemical Phenotype of Adolescent Males with Gynecomastia. J Clin Res Pediatr Endocrinol 2019; 11:388-394. [PMID: 31117335 PMCID: PMC6878348 DOI: 10.4274/jcrpe.galenos.2019.2019.0027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Gynecomastia is defined as a benign proliferation of male breast glandular tissue. Its prevalence during puberty varies between 50-60% and is also common in neonatal and elderly males. It develops mainly due to the disequilibrium between estrogen and androgen activity in breast tissue, where estradiol (E2) binds to estrogen receptors and stimulates ductal and glandular cells. The aim of this work was to investigate the relationship between sex hormone alterations and the natural history of gynecomastia. METHODS Participants in this study were young males referred to an outpatient clinic, between January 2011 and February 2016, with breast enlargement. Thyroid function, liver function, hormone concentrations and tumor markers were measured and anthropometric assessment was conducted. RESULTS Subjects comprised 93 males, aged 9 to 18 (mean±standard deviation age 13.8±2.6) years. In 63 of 93 (67.7%) the gynecomastia was confirmed and 28 were followed-up for a median period of three months. None of the boys showed any reduction in breast size during follow-up. There was no correlation between body mass index Z-score and breast size. Breast enlargement progressed in nine boys (32.1%). A positive correlation between estrogen to testosterone (E2/TTE) ratio and Tanner B stage (r=0.47; p=0.034) was observed. CONCLUSION The E2/TTE ratio may be a helpful tool in diagnosing gynecomastia. Altered E2/TTE ratio might be responsible for a proportion of cases described previously as idiopathic. Additionally, weight loss does not imply reduction of breast size in boys. Nonetheless it should be the first step in the management of prolonged gynecomastia.
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Affiliation(s)
- Miłosz Lorek
- Medical University of Silesia Faculty of Medicine, Department of Pediatrics and Pediatric Endocrinology, Katowice, Poland,* Address for Correspondence: Medical University of Silesia Faculty of Medicine, Department of Pediatrics and Pediatric Endocrinology, Katowice, Poland Phone: +0048664943295 E-mail:
| | - Dominika Tobolska-Lorek
- Medical University of Silesia Faculty of Medicine, Department of Pediatrics and Pediatric Endocrinology, Katowice, Poland
| | - Barbara Kalina-Faska
- Medical University of Silesia Faculty of Medicine, Department of Pediatrics and Pediatric Endocrinology, Katowice, Poland
| | | | - Aneta Gawlik
- Medical University of Silesia Faculty of Medicine, Department of Pediatrics and Pediatric Endocrinology, Katowice, Poland
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Batteux B, Llopis B, Muller C, Khouri C, Moragny J, Liabeuf S, Masmoudi K, Gras V. The drugs that mostly frequently induce gynecomastia: A national case - noncase study. Therapie 2019; 75:225-238. [PMID: 31471065 DOI: 10.1016/j.therap.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/02/2019] [Accepted: 06/14/2019] [Indexed: 12/18/2022]
Abstract
AIMS Drug-induced gynecomastia accounts for up to 25% of cases of gynecomastia. The objective of the present study was to provide a comprehensive overview of drug-induced gynecomastia on the basis of spontaneously reported adverse drug reactions (ADRs) in the French national pharmacovigilance database (FPVD). METHODS We performed a case - noncase study of drug-induced gynecomastia. Cases corresponded to reports of gynecomastia recorded in the FPVD between 1 January 2008 and 31 December 2015. The noncases corresponded to all other spontaneously reported ADRs recorded in the FPVD during the same period. Data were expressed as the reporting odds ratio (ROR) and its 95% confidence interval. RESULTS Of the 255,354 ADRs recorded in the FPVD between 1 January 2008 and 31 December 2015, 327 (0.31%) of relevant cases of gynecomastia and 106,800 noncases were analyzed. The RORs were statistically significant for 54 active compounds mentioned 429 times in cases of gynecomastia. A single drug was involved in 59% of cases. The most frequently implicated drug classes were antiretrovirals (23.5%), diuretics (15.5%), proton pump inhibitors (11.9%), HMG-CoA reductase inhibitors (9.1%), neuroleptics and related drugs (6.5%), calcium channel blockers (6.3%), and 5-alpha reductase inhibitors (4%). CONCLUSIONS A comprehensive analysis of a national pharmacovigilance database highlighted the main drug classes suspected of inducing gynecomastia. A physiopathological mechanism (a hormone imbalance with elevated estrogen levels) is known or suspected for most of the drugs involved in gynecomastia. However, we noticed a lack of harmonization in the summary of product characteristics for original vs. generic medicines.
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Affiliation(s)
- Benjamin Batteux
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France.
| | - Benoît Llopis
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Charlotte Muller
- Centre régional de pharmacovigilance, hôpital civil, 67091 Strasbourg, France
| | - Charles Khouri
- Centre régional de pharmacovigilance, CHU Grenoble, 38043 Grenoble, France
| | - Julien Moragny
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Sophie Liabeuf
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Kamel Masmoudi
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
| | - Valérie Gras
- Centre régional de pharmacovigilance, CHU Amiens Sud, avenue René Laënnec, 80054 Amiens cedex 1, France
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Magudia K, Menias CO, Bhalla S, Katabathina VS, Craig JW, Hammer MM. Unusual Imaging Findings Associated with Germ Cell Tumors. Radiographics 2019; 39:1019-1035. [PMID: 31125295 DOI: 10.1148/rg.2019180050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Germ cell tumors, because they contain immature and mature elements, can differentiate into different tissue types. They can exhibit unusual imaging features or manifest in a syndromic fashion. The authors describe these features and assign them to one of the following categories: (a) unusual manifestations of metastatic disease (growing teratoma syndrome, choriocarcinoma syndrome, ossified metastases, and gliomatosis peritonei); (b) autoimmune manifestations (sarcoidlike reaction and paraneoplastic syndromes); (c) endocrine syndromes (sex hormone production, struma ovarii, and struma carcinoid); or (d) miscellaneous conditions (ruptured dermoid cyst, squamous cell carcinoma arising from a mature teratoma, Currarino triad, fetus in fetu, pseudo-Meigs syndrome, and pancreatitis). Rare conditions associated with germ cell tumors demonstrate characteristic imaging findings that can help lead to the appropriate diagnosis and management recommendations. When evaluating for potential metastatic disease, alternative benign diagnoses should be considered (eg, growing teratoma syndrome, ossified metastases, ruptured dermoid cyst, gliomatosis peritonei, and sarcoidlike reaction), which may impact management. Germ cell tumors may also lead to life-threatening complications such as extensive hemorrhage from choriocarcinoma metastases or the rupture of mature teratomas, cases in which timely diagnosis is crucial. Autoimmune and endocrine manifestations such as paraneoplastic encephalitis, autoimmune hemolytic anemia, and hyperthyroidism may occur owing to the presence of germ cell tumors and can create a diagnostic dilemma for clinicians. Knowledge of the syndromic and unusual imaging findings associated with germ cell tumors helps guide appropriate management. ©RSNA, 2019.
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Affiliation(s)
- Kirti Magudia
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
| | - Christine O Menias
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
| | - Sanjeev Bhalla
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
| | - Venkata S Katabathina
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
| | - Jeffrey W Craig
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
| | - Mark M Hammer
- From the Departments of Radiology (K.M., M.M.H.) and Pathology (J.W.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); and Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.)
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20
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De Sanctis V, Soliman AT, Daar S, Di Maio S. Adverse events during testosterone replacement therapy in 95 young hypogonadal thalassemic men. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:228-232. [PMID: 31125000 PMCID: PMC6776204 DOI: 10.23750/abm.v90i2.8477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/23/2022]
Abstract
Background: Hormonal treatment of hypogonadism in thalassaemia major (TM) is a complex issue due to the co-existence of other contributing factors such as severity of iron overload, associated chronic liver disease and other endocrine complications. Objectives: Data about adverse events (AEs) of testosterone replacement therapy (TRT) in hypogonadal males with TM is scarce. We report the adverse events registered during TRT in 95 young patients with TM. Results: These AEs included gynecomastia, documented in 41/95 (43.1%) TM patients of mild to moderate severity (90%). Persistent pain in the injection site and local reactions to testosterone (T) skin patch occurred in a third of patients. Priapism was reported in 2 patients on treatment with intramuscular T enanthate. In both patients, substitution with T gel was successful, and no recurrence during the following 24 months was observed. Conclusions: Clinicians should exercise caution when considering TRT for hypogonadal men with TM. (www.actabiomedica.it)
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Kanakis GA, Nordkap L, Bang AK, Calogero AE, Bártfai G, Corona G, Forti G, Toppari J, Goulis DG, Jørgensen N. EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology 2019; 7:778-793. [DOI: 10.1111/andr.12636] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- G. A. Kanakis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology Aristotle University of Thessaloniki Thessaloniki Greece
| | - L. Nordkap
- University Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) Rigshospitalet Copenhagen Denmark
| | - A. K. Bang
- University Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) Rigshospitalet Copenhagen Denmark
| | - A. E. Calogero
- Department of Clinical and Experimental Medicine University of Catania Catania Italy
| | - G. Bártfai
- Department of Obstetrics, Gynecology, and Andrology Albert Szent‐Györgyi Medical University Szeged Hungary
| | - G. Corona
- Medical Department, Endocrinology Unit Azienda Usl, Maggiore‐Bellaria Hospital Bologna Italy
| | - G. Forti
- Department of Experimental Clinical and Biomedical Sciences ‘Mario Serio’, Endocrine Unit University of Florence Florence Italy
| | - J. Toppari
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology Turku University Hospital Turku Finland
| | - D. G. Goulis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology Aristotle University of Thessaloniki Thessaloniki Greece
| | - N. Jørgensen
- University Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) Rigshospitalet Copenhagen Denmark
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Liu J, Han Y, Cheng K, Wang XH, Guo F, Yang ZL. Single-incision surgery for gynecomastia using TriPort: A case report. Exp Ther Med 2018; 16:797-801. [PMID: 30116334 PMCID: PMC6090300 DOI: 10.3892/etm.2018.6224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/26/2018] [Indexed: 11/11/2022] Open
Abstract
Gynecomastia is a common benign condition of the male breast, frequently observed in newborns, adolescents and the elderly. Surgical excision remains one of the most effective methods for the management of patients with gynecomastia, particularly those with fibrosis or a course of >1 year. The present study describes two cases of patients with gynecomastia and presents a novel method of treatment, combining endoscopic surgery and liposuction using a TriPort, which may effectively remove breast tissue and shorten hospitalization time compared with a direct excision method.
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Affiliation(s)
- Jian Liu
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Yong Han
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Kai Cheng
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Xiao-Hong Wang
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Fengli Guo
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Zhen-Lin Yang
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
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Klang E, Kanana N, Grossman A, Raskin S, Pikovsky J, Sklair M, Heller L, Soffer S, Marom EM, Konen E, Amitai MM. Quantitative CT Assessment of Gynecomastia in the General Population and in Dialysis, Cirrhotic, and Obese Patients. Acad Radiol 2018; 25:626-635. [PMID: 29326049 DOI: 10.1016/j.acra.2017.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Gynecomastia is the benign enlargement of the male breast because of proliferation of the glandular component. To date, there is no radiological definition of gynecomastia and no quantitative evaluation of breast glandular tissues in the general male population. The aims of this study were to supply radiological-based measurements of breast glandular tissue in the general male population, to quantitatively assess the prevalence of gynecomastia according to age by decades, and to evaluate associations between gynecomastia and obesity, cirrhosis, and dialysis. MATERIALS AND METHODS This retrospective study included 506 men who presented to the emergency department following trauma and underwent chest-abdominal computed tomography. Also included were 45 patients undergoing hemodialysis and 50 patients with cirrhosis who underwent chest computed tomography. The incidence and size of gynecomastia for all the study population were calculated. RESULTS Breast tissue diameters of 22 mm, 28 mm, and 36 mm corresponded to 90th, 95th, and 97.5th cumulative percentiles of diameters in the general male population. Peaks of gynecomastia were shown in the ninth decade and in boys aged 13-14 years. Breast tissue diameter did not correlate with body mass index (r = -0.031). Patients undergoing hemodialysis and patients with cirrhosis had higher percentages (P < .0001) of breast tissue diameters above 22 mm, 28 mm, and 36 mm. CONCLUSIONS Breast tissue diameter is a simple and reliable quantitative tool for the assessment of gynecomastia. This method provides the ability to determine the incidence of gynecomastia by age in the general population. Radiological gynecomastia should be defined as 22 mm, 28 mm, or 36 mm (90th, 95th, and 97.5th percentiles, respectively). Radiological gynecomastia is not associated with obesity, but is associated with cirrhosis and dialysis.
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Kaufman KR, Babalola R, Campeas M, Coluccio M. Bipolar disorder, comorbid anxiety disorders, gynecomastia and dental pain: case analysis with literature review. BJPsych Open 2018; 4:137-141. [PMID: 29971157 PMCID: PMC6020282 DOI: 10.1192/bjo.2018.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/08/2017] [Accepted: 12/14/2017] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Bipolar disorder with comorbid anxiety disorders frequently requires rational polypharmacy, including use of serotonergic psychotropics. These may result in adverse effects, influencing adherence, complicating treatment and confounding diagnoses. Serotonergic non-adherence is associated with discontinuation syndromes. In this complex case with an on/off/on/off design, both dose-dependent buspirone-induced gynecomastia and buspirone discontinuation syndrome with dental pain are reported. Clinicians and patients should consider these findings to maximise treatment adherence, minimise any unnecessary interventions and address unusual adverse effects. Since patients may not voluntarily disclose specific adverse effects and often do not acknowledge non-adherence, clinician-directed questions are required. This case further emphasises the importance of medication and symptom timelines to guide determination of causation for adverse effects. Although findings from this case cannot be generalised, they suggest the need for continued clinician and patient education, as well as the benefit from detailed case reports. DECLARATION OF INTEREST None.
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Affiliation(s)
- Kenneth R Kaufman
- Departments of Psychiatry, Neurology, and Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Ronke Babalola
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Miriam Campeas
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Melissa Coluccio
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Crombé A, Hurtevent-Labrot G, Asad-Syed M, Palussière J, MacGrogan G, Kind M, Ferron S. Shear-wave elastography quantitative assessment of the male breast: added value to distinguish benign and malignant palpable masses. Br J Radiol 2017; 91:20170676. [PMID: 29144159 DOI: 10.1259/bjr.20170676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the ability of shear-wave elastography (SWE) to distinguish between benign and malignant palpable masses of the adult male breast. METHODS Clinical examination, mammography, B-mode and Doppler ultrasound findings and SWE quantitative parameters were compared in 50 benign lesions (including 40 gynaecomastias) and 15 malignant lesions (invasive ductal carcinomas) from 65 patients who were consecutively addressed for specialized advice at our comprehensive cancer centre. Mean elasticity (El mean), maximum elasticity (El max), El mean of the surrounding fatty tissue and lesion to fat ratio (El ratio) were reported for each patient. RESULTS Malignant masses displayed significantly higher El mean (p < 0.0001), El max (p < 0.0001) and El ratio (p < 0.0001) compared to benign masses without overlap of values between the two groups. By adding SWE to clinical examination, mammography and ultrasound, all the lesions would have been retrospectively correctly diagnosed as benign or malignant. One false positive could have been downstaged, 14/65 undetermined masses could have been correctly reclassified as 4 malignant and 10 benign lesions, for which biopsies could have consequently been avoided. CONCLUSION Evaluation of male breast palpable masses by SWE demonstrates that malignant masses are significantly stiffer lesions and may improve diagnostic management when clinical examination, mammography and conventional ultrasound are doubtful. Advances in knowledge: Quantitative SWE is feasible in male breast and could be of great interest to help classify doubtful lesions after classical clinical and radiological evaluations, probably because of different anatomy and different tumours epidemiology compared with female breast.
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Affiliation(s)
- Amandine Crombé
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Gabrielle Hurtevent-Labrot
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Maryam Asad-Syed
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Jean Palussière
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Gaetan MacGrogan
- 2 Department of Pathology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Michèle Kind
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
| | - Stéphane Ferron
- 1 Department of Radiology,Institut Bergonié, Comprehensive cancer centre , Institut Bergonié, Comprehensive cancer centre , Bordeaux , France
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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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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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Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System. Plast Reconstr Surg 2017; 139:638e-648e. [PMID: 28234829 DOI: 10.1097/prs.0000000000003059] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gynecomastia is a common deformity of the male breast, where certain cases warrant surgical management. There are several surgical options, which vary depending on the breast characteristics. To guide surgical management, several classification systems for gynecomastia have been proposed. METHODS A systematic review was performed to (1) identify all classification systems for the surgical management of gynecomastia, and (2) determine the adequacy of these classification systems to appropriately categorize the condition for surgical decision-making. RESULTS The search yielded 1012 articles, and 11 articles were included in the review. Eleven classification systems in total were ascertained, and a total of 10 unique features were identified: (1) breast size, (2) skin redundancy, (3) breast ptosis, (4) tissue predominance, (5) upper abdominal laxity, (6) breast tuberosity, (7) nipple malposition, (8) chest shape, (9) absence of sternal notch, and (10) breast skin elasticity. On average, classification systems included two or three of these features. Breast size and ptosis were the most commonly included features. CONCLUSIONS Based on their review of the current classification systems, the authors believe the ideal classification system should be universal and cater to all causes of gynecomastia; be surgically useful and easy to use; and should include a comprehensive set of clinically appropriate patient-related features, such as breast size, breast ptosis, tissue predominance, and skin redundancy. None of the current classification systems appears to fulfill these criteria.
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Schröder L, Rudlowski C, Walgenbach-Brünagel G, Leutner C, Kuhn W, Walgenbach KJ. Surgical Strategies in the Treatment of Gynecomastia Grade I-II: The Combination of Liposuction and Subcutaneous Mastectomy Provides Excellent Patient Outcome and Satisfaction. Breast Care (Basel) 2015; 10:184-8. [PMID: 26557823 DOI: 10.1159/000381152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gynecomastia (GM) is a benign condition with glandular tissue enlargement of the male breast. GM is classified into 4 grades of increasing severity. We describe a series of GM grade I-II, diagnosed, treated surgically and analyzed regarding feasibility, complication rate, and satisfaction. METHODS From 2005 to 2012, a chart review was performed for 53 patients. Preoperative examination included endocrine and urological examination and exclusion of other pathological conditions. The surgical technique consisted of liposuction through an inframammarian-fold incision and excision of the glandular tissue by a minimal periareolar approach. RESULTS A total number of 53 male patients with 104 breasts were available for analysis. By liposuction, a median of 300 ml (range: 10-1000 ml) was aspirated from each breast and 25.1 g (range: 3-233 g) gland tissue was resected. Surgery lasted between 25 and 164 min per patient (median: 72 min). 2 postoperative hemorrhages occurred (n = 2, 3.8%). 2 patients underwent re-operation due to cosmetic reasons (n = 2, 3.8%). CONCLUSIONS This analysis demonstrates that treatment of GM grade I-II can easily be performed by liposuction combined with subcutaneous resection of the glandular tissue as a minimally invasive and low-impact surgical treatment with a low rate of complications and excellent patient satisfaction. Preoperative workup is important to rule out specific diseases or malignancy causing the GM.
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Affiliation(s)
- Lars Schröder
- Department of Gynecology and Obstetrics and Center for Integrated Oncology (CIO), Cologne/Bonn, University Hospital Bonn, Germany
| | - Christian Rudlowski
- Department of Gynecology and Obstetrics and Center for Integrated Oncology (CIO), Cologne/Bonn, University Hospital Bonn, Germany
| | | | - Claudia Leutner
- Department of Radiology and Center for Integrated Oncology (CIO), Cologne/Bonn, University Hospital Bonn, Germany
| | - Walther Kuhn
- Department of Gynecology and Obstetrics and Center for Integrated Oncology (CIO), Cologne/Bonn, University Hospital Bonn, Germany
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Abstract
Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. At least 30% of males will be affected during their life. Since it causes anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important and patients usually seek medical attention. Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both. Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery. The main aim of any intervention is to relieve the symptoms and exclude other etiological factors.
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Affiliation(s)
- Neslihan Cuhaci
- Departments of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Sefika Burcak Polat
- Departments of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Berna Evranos
- Departments of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Departments of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Departments of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
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Chen PH, Slanetz PJ. Incremental clinical value of ultrasound in men with mammographically confirmed gynecomastia. Eur J Radiol 2014; 83:123-9. [DOI: 10.1016/j.ejrad.2013.09.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/15/2013] [Accepted: 09/22/2013] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Prepubertal gynecomastia is an extremely rare condition usually requiring surgical treatment, especially in case of class III gynecomastia. This study presents cases treated with a new surgical treatment. METHODS From 2010 at our institution, gynecomastia is treated surgically using a modified technique of periareolar incision. Aesthetic results and possible complications of this technique are reported. RESULTS Five patients were treated at the authors' unit for class III gynecomastia between January 2010 and December 2011. All patients were properly treated without the need of further surgery for skin resection. One patient developed seroma, treated with suction; one patient showed hematoma, treated with hot packs for 3 weeks. All patients and their parents were satisfied of the aesthetic results obtained. All patients resumed sport activities 4 weeks after surgery. It was not possible to observe intraoperative complications. CONCLUSION The technique used meets safety and efficacy standards for the treatment of this type of pediatric gynecomastia. It also offers the best possible aesthetic results with minimum complications which can be treated without the need of further surgery.
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Statin-associated gynecomastia: evidence coming from the Italian spontaneous ADR reporting database and literature. Eur J Clin Pharmacol 2012; 68:1007-11. [PMID: 22286160 DOI: 10.1007/s00228-012-1218-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/11/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE The aim of this study was to add to the body of evidence on statin-induced gynecomastia based on data retrieved from the Italian spontaneous adverse drug reaction (ADR) reporting database. METHODS Spontaneous ADR reports collected in the Italian database up to 31 December 2010 were assessed on a case-by-case basis in a search for evidence of a possible causal association between statins and gynecomastia. Cases of gynecomastia or possible gynecomastia, according to the Medical Dictionary of Regulatory Activities (MedDRA) classification, associated with statin use were retrieved from the database. The findings were compared with the available literature in PubMed. RESULTS The database contained 90,448 ADR reports on 21 December 2010. At least one statin was listed as the suspected drug in 2,862 reports, of which 1,334 concerned a male patient. Among these reports, we identified eight cases with the preferred term “gynecomastia” with a statin as suspected drug: four reports of rosuvastatin and four of atorvastatin. One additional report of an unspecified “breast disorder” in a male patient attributed to fluvastatin was identified and included as a possible case. Four case-reports of statin-induced gynecomastia published between 2006 and 2010 were retrieved from PubMed. CONCLUSIONS Our findings suggest an association between gynecomastia and statins as a drug class, and the occurrence of this ADR would appear to be more likely with active substances that show an higher potency in inhibiting HMG-CoA reductase enzyme. To date, the safety information provided on the labels of different statin-containing medicines is not standardized. Harmonization of this information would be helpful for both healthcare practitioners and patients.
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