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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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Jabori SK, Hullfish H, Samaha Y, Becker H, Thaller SR. Unraveling the Enigma: A Rare Case of Recurrent Idiopathic Gynecomastia in an Adolescent. J Craniofac Surg 2024; 35:208-210. [PMID: 37991407 DOI: 10.1097/scs.0000000000009852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/07/2023] [Indexed: 11/23/2023] Open
Abstract
Gynecomastia presents as abnormal hypertrophy of mammary tissue in males that is typically asymptomatic and usually does not require intervention. Gynecomastia responds well to medical and surgical treatment, when necessary, with low recurrence rates. The authors report an atypical case of recurrent idiopathic unilateral gynecomastia first presenting in an adolescent male. Physical examination, hormonal, and oncologic evaluations were normal. After subcutaneous mastectomy with liposuction and treatment with Tamoxifen at 19 years old, his unilateral gynecomastia recurred over the course of 3 years, requiring a second surgery. Furthermore, we review the literature for recurrent gynecomastia after surgical management to examine prevalence and risk factors.
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Affiliation(s)
- Sinan K Jabori
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami
| | - Haley Hullfish
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami
| | | | - Hilton Becker
- Charles E. Schmidt College of Medicine
- Clinic of Plastic Surgery, Florida Atlantic University, Boca Raton, FL
| | - Seth R Thaller
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami
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Ibrahiem SMS. "Post Bariatric Male Chest Re-shaping Using L-shaped Excision Technique". Aesthetic Plast Surg 2023; 47:2502-2510. [PMID: 35715533 DOI: 10.1007/s00266-022-02971-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Male chest deformity after massive weight loss is complex and challenging to treat because of differing grades of excessive parenchyma/fat ptosis, nipple malposition, over-stretched skin, ill-defined infra-mammary fold, and prominent axillary rolls. Patients are eager to restore balanced upper body dominance. Two fundamental techniques are used for large breasts with moderate to poor skin elasticity; (1) the inferior pedicle Wise skin pattern and (2) double incision with free nipple graft technique.The author presents his experience in treating such severe breast deformities, besides correcting the prominent axillary rolls using an L-shaped mastectomy excision. MATERIALS AND METHODS Between March 2017 and December 2020, 55 consecutive patients were treated surgically for male chest re-contouring using the L-shaped mastectomy technique. Ages ranged from 20 to 57 years (median, 31 years). The average body mass index (BMI) was 29. The average follow-up period was 17 months (13-44 months). RESULTS Fifty-one patients (92.8%) reported greater levels of postoperative satisfaction with their results owing to lack of any major complication and minimal minor complications (two cases of minor ischemia that healed spontaneously, two small hematomas, two small seromas, and four hypertrophic scars). CONCLUSION The L-shaped excision is a useful procedure for severe grade gynecomastia with an atypical presentation in the form of complex chest deformity and prominent axillary roll after massive weight loss patients. The technique is associated with minor complications that are treated in an office setting. The technique preserves normal pigmentation and sensitivity of the nipple-alveolar complex. 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)
- Saad Mohamed Saad Ibrahiem
- Assistant Professor of plastic and reconstructive surgery, Faculty of Medicine, Medical Campus, Alexandria University, 21111, Alexandria, Egypt.
- We Care Professionals Medical Center, Kuwait City, Kuwait.
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Lashin R, Youssef RA, Elshahat A, Mohamed EN. Postoperative Psychological Impact on Teenagers after Gynecomastia Correction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5094. [PMID: 37361507 PMCID: PMC10287129 DOI: 10.1097/gox.0000000000005094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/05/2023] [Indexed: 06/28/2023]
Abstract
Gynecomastia is common among teenagers. Most published research focused on how surgery is effective in enhancing the aesthetic appearance of the breast. Limited information is already known about the psychosocial benefits of surgical interventions. This study explores and assesses the surgical, cosmetic, and psychological outcome of gynecomastia correction in teenagers. Methods This prospective study included 20 teenagers with Simon grade IIA gynecomastia. The assessment included complications, patients' satisfaction, Manchester Scar Scale, and Li et al questionnaire at 12 months postoperative. Rosenberg Self-Esteem Scale, 36-Item Short Form Survey (SF-36) for quality of life, and school achievement level were evaluated 1 month preoperative and 12 months postoperative. Statistical analysis was done. Results Patients were aged 13-19 years old. The follow-up period was 12 ± 36 months. Postoperative complications included seroma formation (n = 1) and mild asymmetry (n = 3). Results were "uniformly good to excellent" on a satisfaction scale. The Manchester Scar Scale shows the lowest score, which denotes the highest outcomes. The Li et al questionnaire showed a positive overall change. Comparing Rosenberg Scale scores pre- and postoperatively revealed higher scores postoperatively, which indicate higher self esteem. Comparing SF-36 pre- and postoperatively showed a significant increase in postoperative quality of life. Comparing school achievement pre- and postoperatively showed marked improvement postoperatively. Results were highly statistically significant. Conclusions Surgical treatment of teenage gynecomastia is beneficial for different psychosocial domains. Pull-through of the mammary gland combined with liposuction provides satisfactory cosmetic results. Patients who underwent surgery reported a significant improvement in psychosocial load, better school achievement, higher quality of life, and better self-esteem.
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Affiliation(s)
- Riham Lashin
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ramy A. Youssef
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Elshahat
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman Nagy Mohamed
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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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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Hong JY, Park SJ, Kim SY, Kim BJ. Efficacy and Safety of Cold-Induced Noninvasive Targeted Fat Reduction in Pseudogynecomastia. Ann Dermatol 2022; 34:412-418. [PMID: 36478423 PMCID: PMC9763905 DOI: 10.5021/ad.21.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/20/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Treatment options for pseudogynecomastia are limited, and the demand for noninvasive breast fat reduction is increasing. OBJECTIVE We evaluated the efficacy and safety of a cold-induced lipolysis device for treating pseudogynecomastia. METHODS In this 16-week prospective trial, a total of 15 male patients with pseudogynecomastia were treated twice with cryolipolysis. The primary endpoint was a change in the chest circumference from baseline at posttreatment week 8. Secondary endpoints were changes in body weight, fat thickness assessed using ultrasonography, independent evaluator- and patient-rated improvement, and Simon's gynecomastia class (SGC) grading. RESULTS The primary assessment, a reduction of 3.05 cm in the mean chest circumference at 8 weeks post-treatment compared to baseline, was statistically significant. The treatment effect was cumulative, with a steady decrease in chest circumference and fat thickness over the 16-week study period. The mean pain score immediately after the first session of treatment was 2.0±1.36, based on a scale of 0~10, with a score of 10 being the worst pain ever experienced. The pain decreased substantially after the end of the procedure. CONCLUSION Cryolipolysis was demonstrated to be an effective and safe option for reducing breast fat in pseudogynecomastia. Male with mild to moderate breast enlargement without skin excess can be ideal candidates.
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Affiliation(s)
- Ji Yeon Hong
- Department of Dermatology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Su Jung Park
- Department of Dermatology, Chungnam National University Sejong Hospital, Sejong, Korea.,Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | | | - Beom Joon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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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, Innocenti M. Gynecomastia and Chest Masculinization: An Updated Comprehensive Reconstructive Algorithm. Aesthetic Plast Surg 2021; 45:2118-2126. [PMID: 33939025 DOI: 10.1007/s00266-021-02275-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gynecomastia is a common finding in males. Clinical aspect varies widely in world populations showing peculiar hallmarks according to different body shapes reflecting personal expectations; therefore, a surgical plan must be tailored on individual basis to all type of patients. MATERIALS AND METHOD A total of 522 patients, treated for bilateral gynecomastia from January 2007 to January 2019, were included and reviewed in this retrospective study. Considering physical status BMI, muscular trophism, hypertrophy of the mammary region, nipple-areola disorder, gland and skin cover consistency, a four-tier classification system has been used to classify the deformity and to assess a surgical plan. In all cases, a subcutaneous mastectomy was performed under direct vision. RESULTS No recurrence of the deformity was observed as well as major complications such as necrosis, and high level of satisfaction was observed in all groups. No breast cancer was found at the histological examinations Operative time ranged from 25 minutes up to 120 minutes and hospitalization time ranged from 1 to 3 days. CONCLUSION Since the physical status is strictly related to the clinical features of the disorder, a comprehensive classification system and a reconstructive algorithm are proposed. 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)
- Alessandro Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.
| | - Dario Melita
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy
| | - Marco Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy
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The Vacuum-Assisted Breast Biopsy System is an Effective Strategy for the Treatment of Gynecomastia. Aesthetic Plast Surg 2021; 45:404-410. [PMID: 32886161 DOI: 10.1007/s00266-020-01931-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gynecomastia is the most common benign disease in males with an increasing prevalence in recent years. It may cause local pain and psychological disorders. The vacuum-assisted breast biopsy system has been reported to be a novel surgical approach for the treatment of gynecomastia. However, there are little detailed reports comparing the curative effect between traditional surgery and vacuum-assisted breast biopsy for gynecomastia. Besides, there was little study which compared the application of two different systems for the treatment of gynecomastia. Our study aimed to investigate the effectiveness of vacuum-assisted breast biopsy systems for patients with gynecomastia. METHODS We retrospectively reviewed 83 patients with gynecomastia between January 2015 and December 2019. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. The characteristics of patients as well as the curative effects between the two groups were analyzed. The two vacuum-assisted breast biopsy systems (Mammotome and Encor) were performed for the patients with gynecomastia. The efficacy, safety, complications, and patient satisfactions were recorded during postoperative follow-up periods. RESULTS Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 ± 1.3 cm vs 0.8 ± 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 ± 2.4 ds vs 3.1 ± 1.6 ds, p < 0.001). Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. There were no statistically significant differences between the two vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. In addition, no serious complications were observed in vacuum-assisted breast biopsy group. All the patients recovered well and were satisfied with the cosmetic outcomes. CONCLUSION The vacuum-assisted breast biopsy system can be used as a feasible and minimally invasive approach for the 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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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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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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Braunstein GD. What Accounts for the Increased Incidence of Gynecomastia Diagnosis in Denmark from 1998-2017? J Clin Endocrinol Metab 2020; 105:5876410. [PMID: 32710775 PMCID: PMC7431205 DOI: 10.1210/clinem/dgaa485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Glenn D Braunstein
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Correspondence and Reprint Requests: Glenn D. Braunstein, MD, 9 Chatham Ct, Newport Beach, CA 92660. E-mail:
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Lee SG, Park PJ, Lee SR, Koo BH, Byun GY, Kim MJ, Kang HJ, Kim S, Oh BS, Lee YH. Influence of Postoperative Finasteride Therapy on Recurrence of Gynecomastia After Mastectomy in Men Taking Finasteride for Alopecia. Am J Mens Health 2020; 13:1557988319871423. [PMID: 31552775 PMCID: PMC6764051 DOI: 10.1177/1557988319871423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Finasteride is commonly used for treatment of alopecia. Because finasteride is a
cause of gynecomastia, there is concern regarding the continuation of
finasteride therapy after mastectomy. No studies have been performed to
determine whether finasteride should be continued after mastectomy when
gynecomastia occurs in patients taking finasteride for the treatment of
alopecia. The researchers studied the effects of finasteride on gynecomastia
recurrence after mastectomy in men with gynecomastia taking finasteride for
alopecia. The researchers retrospectively evaluated 1,673 patients with
gynecomastia who underwent subcutaneous mastectomy with liposuction at Damsoyu
Hospital from January 2014 to December 2016. In total, 52 of the patients were
taking finasteride for alopecia before surgery and continued to use it in the
same manner after mastectomy. Ultrasonography was performed 1 year after
mastectomy. The patients’ median age was 26.5 (24.75–30) years. All 52 patients
had bilateral gynecomastia. The median duration of finasteride therapy before
and after surgery was 12 (5–25.75) and 33 (27.5–40.5) months, respectively.
There were no statistically significant differences between the groups with and
without the use of finasteride in relation to postoperative complications and
recurrence rates. Taking finasteride seems to have little effect on recurrence
in patients with alopecia who have undergone surgical treatment of gynecomastia.
Surgeons may recommend continuous finasteride therapy in patients with alopecia
who wish to take finasteride after mastectomy.
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Affiliation(s)
- Seung Geun Lee
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Pyoung Jae Park
- Department of Surgery, Korea University
Guro Hospital, Korea University College of Medicine, Guro-gu, Seoul, Republic of
Korea
| | - Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
- Sung Ryul Lee, MD, PhD, Department of
Surgery, Damsoyu Hospital, 234 Hakdong-ro, Gangnam-gu, Seoul, 06104, Republic of
Korea.
| | - Bum Hwan Koo
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Geon Young Byun
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Myoung Jin Kim
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Hyok Jo Kang
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Sarang Kim
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
- Research Centre, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Beom Seok Oh
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
- Research Centre, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
| | - Young Hyun Lee
- Department of Surgery, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
- Research Centre, Damsoyu Hospital,
Gangnam-gu, Seoul, Republic of Korea
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Tripathy S, Sharma R, Likhyani A, Sharma RK. Invited Response on: Prospective Analysis and Comparison of Periareolar Excision (Delivery) Technique and Pull-Through Technique for the Treatment of Gynecomastia. Aesthetic Plast Surg 2020; 44:1091-1092. [PMID: 32246213 DOI: 10.1007/s00266-020-01696-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Satyaswarup Tripathy
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Raman Sharma
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Abhinav Likhyani
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ramesh Kumar Sharma
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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16
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Wang Y, Wang J, Liu L, Liang W, Qin Y, Zheng Z, Zou S, Xu Y, Chen C, Feng Z, Zhang J, Tao L, Chen X. Comparison of curative effects between mammotome‐assisted minimally invasive resection (MAMIR) and traditional open surgery for gynecomastia in Chinese patients: A prospective clinical study. Breast J 2019; 25:1084-1089. [PMID: 31267613 DOI: 10.1111/tbj.13424] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Yu Wang
- Department of Head Neck Thyroid and Mammary Surgery Tumor Hospital of Mudanjiang City Mudanjiang Heilongjiang China
| | - Jiyan Wang
- Department of Mammary Surgery The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | - Lin Liu
- Department of Mammary Surgery The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | - Wenlong Liang
- Department of Mammary Surgery The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | - Youyou Qin
- Department of Mammary Surgery The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | - Zihao Zheng
- Department of Mammary Surgery The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | - Shifang Zou
- Department of Mammary Surgery The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | - Yuting Xu
- Department of Mammary Surgery Affiliated Cancer Hospital of Harbin Medical University Harbin Heilongjiang China
| | - Cuicui Chen
- Campus Direct Outpatient Department Harbin Medical University Harbin Heilongjiang China
| | - Zhenchu Feng
- Department of Mammary Surgery The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | - Jianguo Zhang
- Department of Mammary Surgery The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | - Lin Tao
- Inpatient Department of Ultrasound Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | - Xi Chen
- Department of Mammary Surgery The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
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17
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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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18
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Nuzzi LC, Firriolo JM, Pike CM, Cerrato FE, DiVasta AD, Labow BI. The Effect of Surgical Treatment for Gynecomastia on Quality of Life in Adolescents. J Adolesc Health 2018; 63:759-765. [PMID: 30279103 DOI: 10.1016/j.jadohealth.2018.06.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Despite the psychosocial deficits associated with gynecomastia, surgical treatment of adolescent gynecomastia remains controversial. This longitudinal cohort study measures changes in health-related quality of life following surgical treatment of gynecomastia in adolescents. METHODS The following surveys were administered to adolescents with gynecomastia and male controls, aged 12-21 years: Short-Form 36v2 (SF-36), Rosenberg Self-Esteem Scale (RSES), and Eating-Attitudes Test-26. Subjects completed surveys at baseline and postoperatively/at follow-up at 6 months, 1 year, 3 years, and 5 years. RESULTS From 2008 to 2017, 44 patients undergoing surgical treatment of gynecomastia and 64 unaffected male controls participated in our study. At baseline, gynecomastia patients scored significantly worse than controls on the RSES and in five SF-36 domains: general health, vitality, social functioning, role-emotional, and mental health. Scores significantly improved postoperatively on the RSES, and in four SF-36 domains: physical functioning, role-physical, bodily pain, and social functioning. Postoperatively, gynecomastia subjects scored similarly to controls in all SF-36 domains and the RSES. Young and overweight/obese patients and those with severe gynecomastia had the greatest postoperative improvement across survey measures. CONCLUSIONS Surgical treatment of gynecomastia significantly improves the quality of life of adolescents, with measurable improvements in physical and psychosocial functioning. Postoperatively, gynecomastia patients performed comparably to unaffected controls. Surgical treatment of gynecomastia in adolescents and young men has the potential to significantly improve quality of life, particularly in younger and overweight/obese patients and those with moderate to severe gynecomastia. Concerns regarding patient age and body mass index alone should not contraindicate surgery.
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Affiliation(s)
- Laura C Nuzzi
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph M Firriolo
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carolyn M Pike
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Felecia E Cerrato
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amy D DiVasta
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian I Labow
- Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
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19
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Zuidema WP, Oosterhuis JWA, Zijp GW, van der Heide SM, van der Steeg AFW, van Heurn LWE. Early Consequences of Pectus Excavatum Surgery on Self-Esteem and General Quality of Life. World J Surg 2018; 42:2502-2506. [PMID: 29411068 PMCID: PMC6060811 DOI: 10.1007/s00268-018-4526-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background An early observation after chest wall correction is direct inspection from the PE patient of their “new” thorax. Changes in self-perception may give raise to other psychological adaptations. The aim of this study was to evaluate the early changes in the fields of self-esteem, body image and QoL. Methods Prospective observational longitudinal multicenter cohort study. Self-esteem, emotional limitations and general health were assessed using the Child Health Questionnaire (CHQ) in patients under 18 and the World Health Organization Quality of Life Questionnaire-bref (WHOQOL-bref) was used for body image, psychological domain and overall QoL in patients over 16 years of age. Measurements were taken before surgery (T1) and 6 weeks (T2), and 6 months thereafter (T3). Results Scores on post-operative self-esteem were significantly higher compared with scores pre-operatively (p < 0.007). Also body image, psychological domain and emotional limitations showed significant improvement, respectively p < 0.001, p < 0.001, and p < 0.016. Significant improvement in the first three components was mainly achieved in the first 6 weeks post-operative. In emotional limitation, however, the largest change was between 6 weeks and 6 months. Overall quality of life in the WHOQOL-bref and general health domain in the CHQ showed no significant improvement in relation to the pre-operative scores. Conclusion Post-operative PE patients after Nuss procedure showed an improved body image, increased self-esteem and increased psychological resilience in the first 6 months, with the most marked change in the first 6 weeks. Also emotional limitations changed significantly over time. The changes were not large enough to influence general QoL or general health significantly.
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Affiliation(s)
- W P Zuidema
- Pediatric Surgical Center Amsterdam, Emma Children's Hospital AMC, VU-University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - J W A Oosterhuis
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - G W Zijp
- Pediatric Surgery, Juliana Children's Hospital/Haga-Hospital, The Hague, The Netherlands
| | - S M van der Heide
- Cardio-Thoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A F W van der Steeg
- Pediatric Surgical Center Amsterdam, Emma Children's Hospital AMC, VU-University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Center of Research on Psychology in Somatic Disease (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - L W E van Heurn
- Pediatric Surgical Center Amsterdam, Emma Children's Hospital AMC, VU-University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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20
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Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. Gland Surg 2018; 7:S70-S76. [PMID: 30175067 DOI: 10.21037/gs.2018.03.09] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Gynecomastia affects up to two-thirds of the male population. For many patients the psychological impact of the disease is substantial. Surgical treatment is indicated when medical treatments fail. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. Little is known about the effect of surgical treatment on the psychological aspects of the disease. The aim of this review was to identify the psychological domains affected by the disease and the effect of surgical treatment on these. A systematic search of the published literature was performed. All studies on the subject were evaluated for inclusion and six studies were included in the review. Several of the included studies reported improvement in quality of life and several psychological domains after surgical treatment for gynecomastia. Among these domains, are; vitality, emotional discomfort, limitations due to physical aspects and limitations due to pain. Impact of surgical treatment for gynecomastia seems to be beneficial for several psychological domains. The current level of evidence on this subject is very low and future studies, examining the impact of the surgical intervention for gynecomastia on psychological domains, are greatly needed. More data on this subject could improve the pre-operative evaluation of these patients and help identify the patients that will benefit from treatment.
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Affiliation(s)
- Martin Sollie
- Department of Plastic Surgery, Odense University Hospital, Odense C, Denmark
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21
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Barone M, Cogliandro A, Morelli Coppola M, Cassotta G, Di Stefano N, Tambone V, Persichetti P. Patient-reported outcome measures following gynecomastia correction: a systematic review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1375-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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22
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Fricke A, Lehner GM, Stark GB, Penna V. Editor's Invited Commentary on "Discussion: Long-Term Follow-Up of Recurrence and Patient Satisfaction After Surgical Treatment of Gynecomastia". Aesthetic Plast Surg 2017; 41:1244-1245. [PMID: 28451798 DOI: 10.1007/s00266-017-0884-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 11/27/2022]
Affiliation(s)
- A Fricke
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Faculty of Medicine, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - G M Lehner
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Faculty of Medicine, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - G B Stark
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Faculty of Medicine, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - V Penna
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Faculty of Medicine, Hugstetter Strasse 55, 79106, Freiburg, Germany
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23
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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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