External periareolar incision for subdermal mastectomy in men with gynecomastia

Álvaro Montiel-Jarquín; Pedro Reyes-Páramo; Gloria Ramos-Álvarez; Aurelio López-Colombo; Magdalena Tinajero-Esquivel; Betzabé Ruiz-León

2007, Number 5

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Cir Cir 2007; 75 (5)

External periareolar incision for subdermal mastectomy in men with gynecomastia

Montiel-Jarquín Á, Reyes-Páramo P, Ramos-Álvarez G, López-Colombo A, Tinajero-Esquivel M, Ruiz-León B

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Language: Spanish
References: 32
Page: 327-331
PDF size: 61.85 Kb.

ABSTRACT

Background: Gynecomastia describes a benign increase of the mammary gland in men. When medical treatment fails, symptoms and psychological alterations persist. Subdermal mastectomy is the definitive treatment and can be achieved by different incisions, each with potential complications. We undertook this study to present clinical characteristics of 11 patients with gynecomastia and the results obtained with subdermal mastectomy by means of external periareolar incision.
Methods: A descriptive cohort study in male patients with gynecomastia was carried out in a third-level medical care hospital. Patients were treated with subdermal mastectomy by means of external periareolar incision.
Results: There were 11 male patients with an average age of 19 years (range: 11-60 years), 3 patients (27.2 %) with bilateral gynecomastia and 8 patients (72.7 %) with unilateral gynecomastia. Average time of evolution was 22 months (range: 16-48 months), 9 patients (81.8 %) reported pain, 11 patients (100 %) reported psychological alterations with cutaneous alteration, 11 patients (100 %) had normal secondary sexual characteristics, 1 patient (9 %) had supernumerary nipple development, and 11 patients (100 %) had well-defined lesions. According to Simon’s classification: seven patients (63.6 %) were classified as grade I, three patients (27.2 %) as grade II and one patient (9.09 %) as grade III. Each patient had a subdermal mastectomy with external periareolar incision, 11 patients (100 %) had a histopathological report of gynecomastia; 1 patient (9.09 %) displayed keloid healing and none displayed complications inherent to the surgical procedure.
Conclusions: Mastectomy by means of external periareolar incision is useful in the treatment of gynecomastia.

REFERENCES

Oroz J, Pelay MJ, Roldán P. Ginecomastia. Tratamiento quirúrgico. An Sist Sanit Navar 2005;28 (suppl 2):109-116.
2. Sopena M, Salvador J. Ginecomastia. Rev Med Univ Navarra 1997;41:42-50.
3. Gruntmanis U, Braunstein GD. Treatment of gynecomastia. Curr Opin Investig Drugs 2001;2:643-649.
4. Gabra HO, Morabito A, Bianchi A, Bowen J. Gynaecomastia in the adolescent: a surgically relevant condition. Eur J Pediatr Surg 2004;14:3-6.
5. Lucas LM, Kumar KL, Smith DL. Gynecomastia. A worrisome problem for the patient. Postgrad Med 1987;82:73-76,79-81.
6. Menville JG. Gynecomastia. Arch Surg 1933;26:1054-1083.
7. Rifka SM, Pita JC, Vigersky RA, et al. Interaction of digitalis and spironolactone with human sex steroid receptors. J Clin Endocrinol Metab 1977;46:338-344.
8. Madani S, Tolia V. Gynecomastia with metoclopramide use in pediatric patients. J Clin Gastroenterol 1997;24:79-81.
9. Khan HN, Blamey R. Endocrine treatment of physiological gynaecomastia. BMJ 2003;327:301-302.
10. Erhan Y, Zekioglu O, Erhan Y. Invasive lobular carcinoma of the male breast. Can J Surg 2006;49:365-366.
11. Creyghton WM, Custers M. Gynaecomastia: is one case enough? Netherlands J Med 2004;62:257-259.
12. Erhan Y, Erhan Y, Zekloglu O. Pure invasive micropapillary carcinoma of the male breast: report of a rare case. Can J Surg 2005;48:156-157.
13. Donegan WL, Redlich PN, Lang PJ, et al. Carcinoma of the breast in males: a multiinstitutional survey. Cancer 1998;83:498-509.
14. Salvadori B, Saccozzi R, Manzari A, et al. Prognosis of breast cancer in males: an analysis of 170 cases. Eur J Cancer 1994:30A:930-935.
15. Séller KS, Rosen PP, Schottenfeld D, Ashkari R, Klinne DW. Male breast cancer: a clinicopathologic study of 97 cases. Ann Surg 1978;188:60-65.
16. Wadie GM, Banever GT, Moriarty KP, Courtney RA, Boyd T. Ductal carcinoma in situ in a 16-year-old adolescent boy with gynecomastia: a case report. J Pediatr Surg 2005;40:1349-1353.
17. Fattaneth A, Tavassoli MD. Pathology of the breast. 2nd ed. New York: McGraw-Hill; 1992. pp. 829-830.
18. Bannayan GA, Hajdn SI. Gynecomastia: clinicopathologic study of 351 cases. Am J Clin Pathol 1972;57:431-437.
19. Cianchetti E, Legnini M, Ucchino S, Ricci A, Scipione P, Grossi S, et al. Gynecomastia. Ann Ital Chir 1996;67:495-499.
20. Mathur R, Braunstein GD. Gynecomastia: pathomechanisms and treatment strategies. Horm Res 1997;48:95-102.
21. Rosenberg GJ. Gynecomastia: suction lipectomy as a contemporary solution. Plast Reconstr Surg 1987;80:379-386.
22. Gasperoni C, Salgarello M, Gasperoni P. Technical refinements in the surgical treatment of gynecomastia. Ann Plast Surg 2000;44:455-458.
23. Smoot EC. Eccentric skin resection and purse-string closure for skin reduction with mastectomy for gynecomastia. Ann Plast Surg 1998;41:378-383.
24. Tashkandi M, Al Catan M, Hassanain JM, et al. The surgical management of high-grade gynecomastia. Ann Plast Surg 2004;53:17-20.
25. Ramon Y, Fodor L, Peled IJ, Leedor L, Egozi D, Ullman Y. Multimodality gynecomastia repair by cross-chest power-assisted superficial liposuction combined with endoscopic-assisted pull-through excision. Ann Plast Surg 2005;55:591-594.
26. Gioffre F, Alfio AR, Fama F, Giacobbe G, Pollicino A, Scarfo P. Evaluation of complications and long-term results after surgery for gynaecomastia. Chir Ital 2004;56:113-116.
27. Coskun A, Duzqun LA, Bóxer M, Akinci OF, Uzunkoy A. Modified technique for correction of gynaecomastia. Eur J Surg 2001;167:822-824.
28. Bauer T, Gruber S, Todoroff B. Peri-areolar approach in pronounced gynecomastia with focus-plasty and liposuction. Chirur 2001;72:433-436.
29. Simon BE, Hoffman S, Khan S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg 1973;51:48-56.
30. Vasseur C, Martino TV, Hodin E, Patenotre P, Pellerin P. Gynecomastia. Management of diagnosis and therapy. Apropos of 52 cases. Ann Chir 1998;52:146-157.
31. Martínez-del Castillo ML, Maderna-Graciano O, Camacho-González F, García-Soldevilla N, Gaztambide-Casellas. Ginecomastia puberal. Revisión de nueve casos. Cir Pediatr 2004;17:80-84.
32. Latarjet M, Ruíz Liard A. Glándula mamaria, PNA. En: Anatomía humana. 3a. ed. España: Panamericana; 1999; vol II. pp. 1779-1786.