Peri-areolar double-pedicle technique in the treatment of iatrogenic gynecomastia

Objectives:To describe the surgical approach to the treatment of iatrogenic gynecomastia via peri-areolar incision.Methods:In this study, we describe our experience in the surgical management of iatrogenic hormonal gynecomastia with our technique described for idiopathic gynecomastia. We treated 70 patients with gynecomastia at a plastic surgery unit between 2000 and 2016. Ten of these patients had a painful hypertrophic mammary gland with grade III gynecomastia secondary to hormone therapy after prostate cancer.Results:The presence of a very discreet scar around the areola often has very interesting aesthetic results. Areolar tissue sensation was completely preserved in 40% of patients. No short-term complications were observed; in follow-up, only one case of keloid scars was noted on a patient with dark skin, and only one case of areolar necrosis on a patient with critical breast ptosis.Conclusion:This technique is feasible. It restores almost normal anatomy structure with minimal scarring and preserves good regional neurovascular supply, with only 60% altered areolar sensation.     

探讨B超在男性乳腺发育症的Cohen分型及整形外科治疗中的应用

目的 探讨利用乳房B超检查,进行男性乳腺发育症的Cohen分型及指导整形外科手术治疗的可行性.方法 近3年来,在男性乳腺发育的患者术前均行乳房B超检查,标记患者胸壁乳腺范围并确定Cohen分型,根据分型采用不同术式,指导术中操作.治疗男性乳腺发育患者共40例,其中腺体型患者行腺体切除术.脂肪型患者行脂肪抽吸术,腺体脂肪型患者则联合应用两种手术方式,先行脂肪抽吸,再切除腺体,必要时再次进行脂肪抽吸.结果 术中切除单侧乳房腺体重量为30～180 g,抽吸脂肪总量为200～1 200 ml.手术方法简便,手术损伤小,并发症少,疗效好.随访6个月至3年.疗效满意、外观良好、切口瘢痕轻微.结论 根据乳房B超的检查结果 ,对男性乳腺发育患者进行Cohen分型,指导手术方式选择及辅助术中操作,能够减少手术创伤及并发症,获得良好的手术效果.     

38例男性乳腺发育症高频彩超诊断分析

目的探讨男性乳腺发育症高频彩色多普勒超声诊断的临床价值。方法对2006年6月至2008年1月诊断的38例男性乳房发育症的声象图特征进行回顾性分析总结。结果血流动力学为中阻值，增生之乳腺中央或偏侧可见1-2条血管，血流丰富程度为Ⅰ级，血流阻力指数为中等。结论高频超声诊断男性乳腺发育症准确、简便、无创伤，具有较高的临床应用价值。     

肿胀麻醉微创治疗青春期男性乳腺增生症

目的探讨应用肿胀麻醉乳晕切口微创治疗青春期男性乳腺增生症的临床经验。方法采取肿胀麻醉乳晕切口微创治疗39例青春期男性乳腺增生症患者。结果39例患者均手术顺利，术后无一例出现血肿、感染、乳头乳晕坏死，胸部平整对称。随访28例，时间为6～12个月，术区瘢痕不明显，胸部平坦，无复发。结论肿胀麻醉乳晕切口微创治疗青春期男性乳腺增生症是一种操作简单、安全性高、彻底的治疗方法。     

Primary Non-Hodgkin Malignant Lymphoma of the Male Breast

A case of primary non-Hodgkin lymphoma of the male breast isreported. The patient was a 76-year-old Japanese with a historyof bilateral gynecomastia. After the patient had received sexhormone treatment for the gynecomastia, rapid growth of a tumorin the right breast was noted, with regression of a contralateralbreast lesion. Clinically, inflammatory breast cancer was suspected,and right mastectomy with ipsilateral axillary lymph node dissectionwas performed after intraarterial infusion chemotherapy usinga cis-platinum derivative. The histology of the surgical specimenwas non-Hodgkin malignant lymphoma of the diffuse large celltype, with focal tumor necrosis. Immunohistochemically, thetumor cells showed a B-cell nature. The patient is currentlywell without disease 39 months after surgery.     

Inferior pedicle reduction technique for larger forms of gynecomastia

The treatment of larger types of gynecomastia is significantly different than that of less severe gynecomastias. Special concerns of the former include aerola enlargement, nipple-areola ptosis, and redundant skin. Many procedures have been described to address these issues, none of which is completely satisfactory; these are reviewed here. Unsatisfactory results may be due to residual breast hypertrophy, skin redundancy, complications related to nipple-aerola placement, form and viability, and cosmetically unacceptable scars. We describe a new technique that uses an inferior pedicle to reposition the nipple-aerola complex and to maintain its neurovascular integrity and form. A superiorly based chest wall flap in conjunction with suction-assisted lipectomy maximizes chest wall contour. There are no breast mound scars, only a periareolar and inframammary scar.     

Concurrent male gynecomastia and testicular hydrocele after imatinib mesylate treatment of a gastrointestinal stromal tumor

We report a gastrointestinal stromal tumor (GIST) patient with male gynecomastia and testicular hydrocele after treatment with imatinib mesylate. A 42 yr-old male patient presented for management of hepatic masses. Two years earlier, he had undergone a small bowel resection to remove an intraabdominal mass later shown to be a GIST, followed by adjuvant radiation therapy. At presentation, CT scan revealed multiple hepatic masses, which were compatible with metastatic GIST, and he was prescribed imatinib 400 mg/day. During treatment, he experienced painful enlargement of the left breast and scrotal swelling. Three months after cessation of imatinib treatment, the tumors recurred, and, upon recommencing imatinib, he experienced painful enlargement of the right breast and scrotal swelling. He was diagnosed with male gynecomastia caused by decreased testosterone and noncommunicative testicular hydrocele. He was given androgen support and a hydrocelectomy, which improved his gynecomastia. The mechanism by which imatinib induces gynecomastia and hydrocele is thought to be associated with an inhibition of c-KIT and platelet-derive growth factor. This is the first report, to our knowledge, describing concurrent male gynecomastia and testicular hydrocele after imatinib treatment of a patient with GIST.     

Gynecomastia Treatment with Subareolar Glandular Pedicle

Background Gynecomastia is enlargement of the male breast. Although treatment is not indicated in most cases, aesthetic reconstructive surgery is commonly performed for psychological reasons. The goals in surgical treatment are to restore the breast contour with minimal scar and to protect areolar anatomy and sensation. This clinical study investigates the results of the subareolar glandular pedicle technique, in which the pedicle is dissected 2 mm wider than the areola with a circumareolar incision and the breast tissue is excised en bloc. The technique differs from the classical circumareolar approach with its thinner pedicle and excision of the breast without leaving prepectoral tissue.Methods We operated on nine patients with grades 1 and 2 gynecomastia using the subareolar glandular pedicle. Exposure was excellent with the circumareolar incision. Neither hematoma nor seroma formation was seen in any of the patients. Partial areola necrosis, which caused suture separation, was the only early postoperative complication seen, and this in a patient who smoked heavily. Patients were followed for at least 6 months.Results Eight patients achieved a good aesthetic contour of the chest, and one patient needed a contour revision for the residual mass because of a bulky pedicle. Circumareolar scars were satisfactory for all the patients, including the patient with partial areola necrosis. Circumareolar hyperpigmentation developed in one patient, and areola sensation was preserved in seven patients.Conclusions The subareolar glandular pedicle is indicated for grades 1 and 2 gynecomastia. Circumareolar incision provides perfect exposure. The technique is reliable if the pedicle is dissected 2 mm wider than the areola and dissection under the pedicle is avoided. Postoperative circumareolar scarring is minimal and nipple–areola sensation is preserved in most cases. However, experience is needed to determine the pedicle girth because a wide pedicle leads to subareolar bulk, whereas a thin pedicle may cause partial areola necrosis.     

Normoprolactinemia in boys with marked gynecomastia

Pubertal gynecomastia normally occurs as a transient phenomenon of several months duration, whereas marked pubertal gynecomastia (more than 6 cm in diameter) may persist into aduldhood. In the present study the possible involvement of prolactin (PRL) secretion in the development of marked pubertal gynecomastia was investigated. The diurnal variations of PRL, luteinizing hormone (LH), follicle-stimulating hormone (FSH), as well as the basal values of testosterone (T) and estradiol (E₂) were determined in 5 pubertal boys with marked gynecomastia and in 5 age-matched controls. Mean age of all patients was 14.4 years. The pubertal development was classified as P 3–4.In comparison to controls, boys with marked gynecomastia revealed no differences in basal values of PRL, LH and FSH, as well as in peak values of all hormones during sleep. The response of PRL, LH and FSH to LHRH/TRH stimulation was normal for pubertal age in both groups. In comparison to controls, decreased mean plasma T levels (P<0.05) and slightly increased E₂ levels (P<0.05) were found in boys with marked gynecomastia. The E₂/T ratio was also higher in boys with gynecomastia (P<0.005).These data suggest that prolactin, a hormone which may be increased in galactorrhea, is not involved in the development of marked pubertal gynecomastia in boys. The above findings suggest that slightly elevated day-time E₂ levels may be involved in the development of female-appearing breasts in pubertal boys.     

Liposuction through an axillary incision for treatment of gynecomastia

Using Webster's technique for treating gynecomastia, the removal of the excess breast tissue is facilitated by the use of liposuction introduced through the axillary incision. In the case of pseudogynecomastia, only liposuction, via the axillary, approach is recommended.