Tratamento cirúrgico de ginecomastia grau III com a técnica de cicatriz horizontal e transposição do complexo areolopapilar - "No vertical scar" / Surgical treatment of grade III gynecomastia with the horizontal scar technique and transposition of the nipple-areolar complex - "No vertical scar"

Introdução: A demanda por cirurgia para correção de ginecomastia tem aumentado em função da grande quantidade de pacientes submetidos a tratamentos bariátricos. A maioria destes pacientes requerem grande remoção do excesso de pele, tecido gorduroso e reposicionamento do complexo areolopapilar, assim como adequação do volume da aréola. O objetivo deste estudo é descrever a técnica de correção de ginecomastia grau III através de cicatriz horizontal sem cicatriz vertical, com reposicionamento do complexo areolopapilar. Método: Estudo prospectivo de 27 pacientes masculinos com diagnóstico de ginecomastia grau III da classificação de Simon, operados em clínica particular, entre janeiro de 2013 e agosto de 2020, pela técnica de cicatriz horizontal com transposição do complexo areolopapilar e sem cicatriz vertical. Resultados: Foram operados 27 pacientes, num período de 7,5 anos, todos ex-obesos, submetidos previamente a tratamento de perda de peso. A idade variou de 17 a 74 anos, média etária de 52 anos. O peso das peças removidas variou de 175 a 758 gramas, média de 376 gramas. As complicações foram: 1 caso de hematoma tardio (3,7%), 1 caso de seroma (3,7%) e 2 casos de cicatriz hipertrófica (7,4%). Conclusão: O tratamento cirúrgico da ginecomastia grau III através da técnica de cicatriz horizontal, sem cicatriz vertical e com reposicionamento do complexo areolopapilar demonstrou ser efetivo, com baixa morbidade e bons resultados estéticos.

Introduction: The demand for surgery to correct gynecomastia has increased due to the many patients undergoing bariatric treatments. Most patients require extensive removal of excess skin, and fatty tissue, repositioning the nipple-areolar complex, and adjusting the areola volume. This study aims to describe the correction technique for grade III gynecomastia using a horizontal scar without a vertical scar, with repositioning of the nipple-areolar complex. Method: Prospective study of 27 male patients diagnosed with Simon grade III gynecomastia, operated in a private clinic between January 2013 and August 2020, using the horizontal scar technique with transposition of the nipple-areola complex and without a vertical scar. Results: 27 patients underwent surgery over 7.5 years, all ex-obese, previously submitted to weight loss treatment. Age ranged from 17 to 74 years, mean age of 52 years. The weight of the removed parts ranged from 175 to 758 grams, an average of 376 grams. Complications were 1 case of late hematoma (3.7%), 1 case of seroma (3.7%), and 2 cases of hypertrophic scarring (7.4%). Conclusion: Surgical treatment of grade III gynecomastia using the horizontal scar technique, without a vertical scar and with repositioning of the nippleareolar complex, proved to be effective, with low morbidity and good aesthetic results.

Mastectomia masculinizadora para redesignação de gênero de transexuais masculinos / Masculinizing mastectomy for male transsexual's gender reassignment

■ RESUMO Introdução: A mastectomia masculinizadora é geralmente o primeiro, o mais importante e muitas vezes o único procedimento cirúrgico na readequação de gênero em transexuais masculinos. O objetivo é descrever e sistematizar os passos da técnica utilizada pelo autor da mastectomia com dupla incisão associado ao enxerto livre de complexo areolopapilar. Métodos: Revisão retrospectiva de 26 pacientes submetidos a mastectomias masculinizadoras (total de 52 mamas), realizadas pela técnica utilizada pelo autor, entre novembro de 2013 e janeiro de 2018. Resultados: 84,6% dos pacientes sofreram a cirurgia com cicatriz final horizontal no sulco inframamário e 15,4% evoluíram com cicatriz final em "T" invertido. A taxa de complicações maiores foi de 3,8%. Houve uma reoperação (3,8%) no período de acompanhamento. O peso médio das mamas foi de 1.136 gramas, a idade média de 27 anos e 9 meses, índice de massa corporal médio de 26,6kg/m2 e 73% dos pacientes receberam terapia com hormônio masculino previamente à cirurgia. Conclusão: A mastectomia masculinizadora é um procedimento seguro, com boa reprodutibilidade e traz resultados estéticos satisfatórios.

■ ABSTRACT Introduction: Masculinizing mastectomy is generally the first, most important and often the only surgical procedure for gender reassignment in male transsexuals. The objective is to describe and systematize the steps of the technique used by the author of the double-incision mastectomy associated with a free graft from the nipple-areola complex. Methods: Retrospective review of 26 patients who underwent masculinizing mastectomies (total of 52 breasts), performed using the technique used by the author, between November 2013 and January 2018. Results: 84.6% of patients had surgery with a final horizontal scar in the inframammary fold, and 15.4% evolved with a final inverted "T" scar. The rate of major complications was 3.8%. There was one reoperation (3.8%) in the follow-up period. Mean breast weight was 1,136 grams, mean age was 27 years and nine months, mean body mass index was 26.6 kg/m2, and 73% of patients received male hormone therapy before surgery. Conclusion: Mastectomy is a safe procedure, with good reproducibility and brings satisfactory aesthetic results.

Ginecomastia: Consideraciones médicas y quirúrgicas en cirugía general / Gynecomastia: Medical and surgical considerations in general surgery

La ginecomastia, definida como el crecimiento del tejido glandular mamario en los hombres, aparece desde la etapa neonatal hasta la senil, puede ser unilateral o bilateral, y es de causa multifactorial, incluyendo aquellos pacientes asociados al uso de medicamentos, donde predomina un desbalance en la relación testosterona­estrógeno. Relativamente, la idiopática es la más frecuente. La mayoría involucionan espontáneamente, las neonatales por perdida del influjo transplacentario en las primeras semanas, y las puberales entre 12 a 24 meses. Se presenta como un aumento del tamaño mamario, asintomático o con hipersensibilidad por inflamación durante el crecimiento del tejido fibroglandular mamario, con una repercusión psicológica enorme, sobre todo en la etapa de la adolescencia. El estudio y manejo es interdisciplinario y se ofrece de acuerdo con las condiciones y la etiología. Aquellos pacientes púberes en quienes no involuciona reciben tratamientos médicos, o tratamientos quirúrgicos cuando falla la terapéutica o hay presión social, e incluso radioterapia en casos donde desarrollan ginecomastia con hipersensibilidad al tratamiento hormonal del cáncer de próstata

Gynecomastia, defined as the growth of breast glandular tissue in men, appears from the neonatal to senile stage, can be unilateral or bilateral, and is of multifactorial cause, including those patients associated with the use of medications, where an imbalance in the testosterone ­ estrogen ratio. Relatively, idiopathic is the most common. Most regress spontaneously, neonatals due to loss of transplacental influx in the first weeks, and pubertal ones between 12 to 24 months. It presents as an increase in breast size, asymptomatic or with hypersensitivity due to inflammation during the growth of the mammary fibroglandular tissue, with an enormous psychological repercussion, especially in adolescence. The study and management is interdisciplinary and offered according to conditions and etiology. Those pubertal patients in whom it does not regress receive medical treatments, or surgical treatments when therapy fails or there is social pressure, and even radiotherapy in cases where they develop gynecomastia with hypersensitivity to hormonal treatment of prostate cancer

Minimally invasive treatment of gynecomastia by ultrasound-guided vacuum-assisted excision: report of a case series

Introduction: Gynecomastia (GM) is a benign proliferation of glandular breast tissue in men. Some cases need surgical intervention. Traditional open surgery by semicircular inferior periareolar incision is the most common surgical approach. In order to obtain better esthetic results, some alternatives to open surgery have been proposed, such as liposuction, endoscopic mastectomy, and vacuum-assisted excision (VAE). Objective: To describe the technical surgical approach of ultrasound-guided VAE of GM and its results from a case series. Method: This is an evaluation of seven GM cases submitted to ultrasound-guided VAE with a 10G needle using the ENCOR® BD whole circumference automated breast biopsy system in Redimasto ­ Redimama, a Brazilian breast center. The result was considered good or satisfactory when it showed minimal remaining gland, good symmetry, no retraction, necrosis, hypertrophic scar, or displacement of the nipple-areola complex. All patients answered a questionnaire to evaluate their satisfaction and perception of the procedure. Results: Seven (7) patients with Simon grade 1 and 2 bilateral GM underwent ultrasound-guided VAE. No case of displacement, necrosis, or retraction of the nipple-areola complex, post-procedure bleeding, infection, skin necrosis, or asymmetry was detected. No patient reported decrease or change in nipple sensation or erection. All patients had bruises and hematomas that spontaneously resolved within 30 days. All results were considered good or excellent by patients and surgeons. Conclusion: Minimally invasive ultrasound-guided VAE is an excellent alternative for the treatment of GM. It is better indicated for Simon grade 1 and 2 GM, with good and excellent esthetic results, small scar, and low rates of nipple and areolar complications. It allows an outpatient procedure with low morbidity (local anesthesia) and fast recovery.

Ginecomastia: aspectos generales y etiológicos / Gynecomastia: general and etiological aspects

La ginecomastia es el crecimiento mamario benigno en el varón. Etiológicamente se clasifica en fisiológica y patológica. La ginecomastia fisiológica se presenta frecuentemente en ciertos periodos de la vida, como la época neonatal, puberal y senil. La patológica se asocia a múltiples factores, incluyendo los hormonales, los de origen tumoral, y al uso de ciertos medicamentos, entre otros; sin embargo, en muchos pacientes no se consigue identificar nunca la causa. La historia clínica y el examen físico son los pilares fundamentales que permiten orientar hacia la etiología, con el apoyo de pruebas de laboratorio e imagenología que permitan descartar una enfermedad clínica subyacente. En los casos moderados o severos, la cirugía es el tratamiento de elección. El objetivo del presente manuscrito es discutir algunos puntos de interés acerca de los aspectos más importantes relacionados con la ginecomastia, incluyendo la fisiopatología, la clínica y el diagnóstico, además de presentar las principales causas asociadas a esta condición. Por último, se describen los tipos de tratamiento disponibles para estos pacientes

Gynecomastia is the benign breast enlargement in males. Etiologically it is classified as physiological and pathological. Physiological gynecomastia is more frequently observed in newborns, adolescents, and in older men. Pathological gynecomastia is associated with multiple factors, including hormonal and of tumor origin, and to the use of certain medications, among other factors; however, in many patients the underlying cause may never be identified. Anamnesis and physical examination are the fundamental pillars that will guide towards the etiology, with the support of laboratory and imaging tests to rule out an underlying disease. In moderate or severe cases, surgery is the treatment of choice. The aim of this article is to discuss some key points about the most important aspects related to gynecomastia, including pathophysiology, symptoms and diagnosis, in addition to presenting the main causes associated with this condition. Finally, the types of treatment available for these patients are described

Role of Fine Needle Aspiration Cytology in Male Breast Lesions.

Fine Needle Aspiration (FNA) is a well-established and widely accepted procedure in the evaluation of breast masses. Fine needle aspiration cytology can be performed as an OPD procedure. It is less traumatic to the patient as compared to surgical biopsy, is cost effective, and can provide rapid results on the same day. Therefore, it can be used as an initial diagnostic procedure for male breast lesions. The aim of our study was to determine the efficacy of Fine-Needle Aspiration Cytology (FNAC) in the diagnosis of male breast lesions and categorization of these lesions as per IAC Categories.METHODSThe present study included 50 cases of male breast lesions presented in the department of the pathology. Fine-Needle Aspiration Cytology (FNAC) was done and slides were stained with MGG and PAP. Findings were analysed by two pathologists independently. Cyto-histological correlation was done in cases wherever possible. Sensitivity and specificity were calculated.RESULTSA total of 50 cases of male breast lesions which had undergone FNAC was analysed in this study. Histopathological examination was available in 10 cases. Gynecomastia C2 (88%) was found to be the most common entity followed by acute on chronic suppurative pathology (4%). There was no false positive or false negative finding. FNAC had a sensitivity and specificity and diagnostic accuracy of 100% for male breast lesions.CONCLUSIONSFNAC is the excellent sensitive and specific diagnostic tool for the assessment of breast lesions in males. Hence, we strongly recommend the use of FNAC as the first-line investigation in the clinical evaluation of male breast lumps.

Caracterización clínico-etiológica y bioquímica de pacientes con ginecomastia / Clinical- etiological and biochemical characterization of patients with gunecomastia

RESUMEN Introducción: La ginecomastia define el aumento benigno del tamaño de la glándula mamaria en el hombre. Objetivo: Determinar las características clínicas, etiológicas y bioquímicas de los pacientes con diagnóstico de ginecomastia atendidos en el servicio de Cirugía General. Método: Se realizó un estudio descriptivo de corte transversal en una muestra de 108 pacientes, mayores de 18 años, atendidos en el servicio de Cirugía General con diagnóstico de ginecomastia. El estudio se llevó a cabo en los Hospitales Mariano Pérez Balí y Celia Sánchez Manduley, entre septiembre 2015 y marzo 2017. Se determinó edad, características clínicas, etiología y perfil bioquímico de estos pacientes. Resultados: La edad media fue de 27,63 años siendo la afectación estética el principal motivo de consulta. Predominó la ginecomastia bilateral, el sobrepeso/obesidad, el grado IIa de la enfermedad, la etiología idiopática y el antecedente de ginecomastia puberal. La presencia de galactorrea, hiperprolactinemia, hipoandrogenismo e hiperestrogenemia fue mínima. Conclusiones: La ginecomastia bilateral de causa idiopática, en pacientes con sobrepeso/obesidad y niveles normales de hormonas hipofisarias y gonadales es la forma de presentación más frecuente de esta afección(AU)

ABSTRACT Introduction: Gynecomastia defines the benign increase of the mammary gland size in men. Objective: To determine the clinical, etiological and biochemical characteristics of patients diagnosed with gynecomastia attended at the General Surgery service. Methods: A descriptive cross-sectional study was conducted in a sample of 108 patients over the age of 18 years, attended at the service of General Surgery with a diagnosis of gynecomastia. The study was carried out in ´´Mariano Perez Bali´´ and ´´Celia Sánchez Manduley´´ Hospitals from September 2015 to March 2017. The age, clinical characteristics, etiology, and biochemical profile of these patients were determined. Results: The mean age was 27.63 years and the aesthetic affectations were the main reason for consultation. There was a predominance of bilateral gynecomastia, overweight/obesity, grade IIa of the disease, idiopathic etiology and the history of pubertal gynecomastia. The presence of hyperprolactinemia, galactorrhea, hypoandrogenism and hyperstrogenism was minimal. Conclusions: Bilateral gynecomastia of idiopathic cause, in patients with overweight/obesity and normal levels of gonadal and pituitary hormones is the most common presentation of this condition(AU)

Prepubertal gynecomastia: a rare manifestation of myotonic dystrophy type 1 / Ginecomastia pré-púbere: uma manifestação rara da distrofia miotônica tipo 1

ABSTRACT Objective: To present a case of bilateral gynecomastia in a prepubertal boy with autism spectrum disorder, diagnosed with myotonic dystrophy type 1. Case description: A 12-year-old boy with autism spectrum disorder presented at a follow-up visit with bilateral breast growth. There was a family history of gynecomastia, cataracts at a young age, puberty delay, and myotonic dystrophy type 1. The physical examination showed that he had bilateral gynecomastia with external genitalia Tanner stage 1. Neurologic examination was regular, without demonstrable myotonia. The analytical study revealed increased estradiol levels and estradiol/testosterone ratio. After excluding endocrine diseases, the molecular study of the dystrophia myotonica protein kinase gene confirmed the diagnosis of myotonic dystrophy type 1. Comments: A diagnosis of prepubertal gynecomastia should include an investigation for possible underlying diseases. This case report highlights the importance of considering the diagnosis of myotonic dystrophy type 1 in the presence of endocrine and neurodevelopmental manifestations.

RESUMO Objetivo: Apresentar o caso de um adolescente pré-púbere com ginecomastia bilateral e transtorno do espectro autista, diagnosticado com distrofia miotônica tipo 1. Descrição do caso: Adolescente do sexo masculino de 12 anos, com transtorno do espectro autista, observado em consulta de seguimento por crescimento mamário bilateral. O paciente tinha antecedentes familiares de ginecomastia, catarata em idade jovem, atraso pubertário e distrofia miotônica tipo 1. À observação física, apresentava ginecomastia bilateral estádio 1 de Tanner. O exame neurológico era normal, sem miotonia aparente. O estudo analítico mostrou níveis elevados de estradiol e da relação estradiol/testosterona. Após exclusão de causas endócrinas, o estudo molecular do gene DMPK confirmou o diagnóstico de distrofia miotônica tipo 1. Comentários: Perante um quadro de ginecomastia pré-púbere, deve-se excluir doenças subjacentes. Este caso reforça a importância de considerar o diagnóstico de distrofia miotônica tipo 1 na presença de manifestações endócrinas e do neurodesenvolvimento.

Clinical significance of MRI in preoperative examination of gynecomastia / 中华医学美学美容杂志

Objective To explore the significance of preoperative MRI in the detection of gynecomastia before surgery.Methods From November 2016 to August 2018,we used preoperative MRI to determine surgical options to treat 38 cases of adolescent and post-adolescent patients with gynecomastia.After operation we followed up the patients for 6 months to 1 year.Results The breast had good shape,smooth chest wall,natural contour,and no complications such as hematoma,nipple and areola sensory disturbance.No surgical traces remained in the chest and no recurrence occurred during the follow-up.All patients were satisfied with the surgical effect and chest wall shape.Conclusions Preoperative MRI can clearly show the type of breast development,the proportion of fat and breast tissue,to guide the clinical personalized design of surgical procedures.It can be used as a routine pre operative examination for gynecomastia.

Endoscopic assisted axillary approach of gynecomastia subcutaneous mastectomy: a prospective cohort study / 中华医学美学美容杂志

Objective To evaluate the clinical outcomes of the endoscopic assisted axillary approach in treating gynecomastia with comparison against the conventional periareolar open excision method,and to present our experience utilizing this technique.Methods Fifty participants diagnosed with gynecomastia were included in this study,among which twenty-six were treated using periareolar open excision,and twenty-four were subjected to endoscopic assisted axillary approach.Clinical out comes and patient reported satisfaction were assessed postoperatively.Results One hematoma (4.2％),one seroma (4.2％),and one wound dehiscence (4.2％) were encountered in the endoscopic assisted axillary group;two hematoma (7.7％) and two nipple hypoesthesia (7.7％) occured in the periareolar group.The total complication rate between the two groups was of no significant differences (P＞0.05).The patient reported satisfaction score of the endoscopic assisted axillarygroup rated sig nificantly higher than the periareolar group on the scar domain (t =2.064,P =0.044).Conclusions Endoscopic assisted axillary approach presents higher patient satisfaction and low complication rate,which is worth widely using in future clinical practice.

Ginecomastia una realidad subestimada: serie de casos / Gynecomasty an underestimated reality: a case series

Introducción: La ginecomastia es una patología benigna frecuente pero muy poco estudiada, caracterizada por el desarrollo de la mama en el hombre dándole una apariencia femenina, lo que puede ocasionar estrés emocional y a su vez retrasa o evita que el paciente acuda a consulta médica especializada. Debido a que no se acompaña de signos de malignidad, la mayoría de médicos generales sólo la consideran una alteración estética; sin embar-go, el tratamiento quirúrgico de fácil realización ayuda al paciente a restaurar su autoestima.Presentación de casos: Durante el periodo febrero ­ noviembre del 2019 se presentaron ocho casos de gineco-mastia que corresponde a la cuarta causa más frecuente de procedimientos quirúrgicos en el Hospital General Quevedo IESS. La edad de los pacientes se ubicó entre 17 y 30 años. El tratamiento quirúrgico de elección fue mastectomía subcutánea. El promedio de estancia hospitalaria fue de 1.3 días, el tiempo de retiro de drenaje as-pirativo fue entre el tercer y quinto día y la complicación quirúrgica más frecuente (50%) fue el seroma.Conclusiones: Esta serie de casos demuestra la importancia del diagnóstico de la ginecomastia, del tratamiento quirúrgico subcutáneo y el cuidado post-quirúrgico para lograr equilibrio biopsicosocial del individuo. Aunque hace falta más evidencia, en lo posible se debería realizar mastectomías subcutáneas que carecen de complica-ciones quirúrgicas graves.

Background: Gynecomastia is a common but little studied benign pathology, characterized by the development of the breast in men giving it a feminine appearance, which can cause emotional stress and in turn delays or prevents the patient from going to a specialized medical consultation. Because it is not accompanied by signs of malignancy, most general practitioners consider it only an aesthetic alteration; however, the easy-to-perform surgical treatment helps the patient restore self-esteem.Cases presentation: Case series: During the period February - November 2019, there were 8 cases of gynecomas-tia, which corresponds to the fourth most frequent cause of surgical procedures at the General Hospital of Quevedo IESS. The age of the patients was between 17 and 30 years. The surgical treatment of choice was subcutaneous mastectomy. The mean hospital stay was 1.3 days, the suction drain removal time was between the third and fifth day, and the most frequent surgical complication (50%) was seroma. Conclusions: This series of cases demonstrates the importance of gynecomastia diagnosis, subcutaneous surgi-cal treatment and post-surgical care to achieve bio-psycho-social balance of the individual. Although more eviden-ce is needed, subcutaneous mastectomies that lack serious surgical complications should be performed whenever possible.

Case report: intraductal papilloma of the male breast / Relato de caso: papiloma intraductal em mama masculina

Breast benign tumors, intraductal papilloma and fibroadenomas are common conditions in women; however, they are very rare in males. In this study, we report the case of a male patient, 75 years old, presenting with complaint of bilateral gynecomastia and palpable retroareolar mass in the left breast. The patient was submitted to imaging tests and core biopsy, and the hypothesis of intraductal papilloma was confirmed upon anatomopathological study. The mastology team opted for excision of the lesion and correction of gynecomastia.

Tumores benignos da mama, papiloma intraductal e fibroadenomas são condições comuns em mulheres, mas muito raras em homens. Neste estudo, relatamos o caso de um paciente do sexo masculino, com 75 anos de idade, cuja queixa era de ginecomastia bilateral e massa retroareolar palpável na mama esquerda. O paciente foi submetido a exames de imagem e core-biopsy, e a hipótese de papiloma intraductal foi confirmada após estudo anatomopatológico. A equipe de mastologia optou pela excisão da lesão e correção da ginecomastia.

Efavirinz induced gynecomastia: a case report

Gynecomastia is swelling of the breast tissue in men, caused by an imbalance of the hormones, estrogen and testosterone. Drugs commonly implicated are spironolactone, cimetidine, ketoconazole, hGH, estrogens, hCG, anti-androgens, GnRH analogues and 5-? reductase inhibitors. Medications probably associated with gynecomastia include risperidone, verapamil, nifedipine, omeprazole, alkylating agents, HIV medications (efavirenz), anabolic steroids, alcohol and opioids. HIV infected patients who are treated with highly active antiretroviral therapy (HAART) can develop breast enlargement due to benign and malignant mammary diseases. We report here a case of gynecomastia due to efavirinz.

Estrogen-secreting adrenocortical carcinoma / 영남의대학술지

Adrenocortical carcinoma is a rare type of endocrine malignancy with an annual incidence of approximately 1–2 cases per million. The majority of these tumors secrete cortisol, and a few secrete aldosterone or androgen. Estrogen-secreting adrenocortical carcinomas are extremely rare, irrespective of the secretion status of other adrenocortical hormones. Here, we report the case of a 53-year-old man with a cortisol and estrogen-secreting adrenocortical carcinoma. The patient presented with gynecomastia and abdominal discomfort. Radiological assessment revealed a tumor measuring 21×15.3×12 cm localized to the retroperitoneum. A hormonal evaluation revealed increased levels of estradiol, dehydroepiandrosterone sulfate, and cortisol. The patient underwent a right adrenalectomy, and the pathological examination revealed an adrenocortical carcinoma with a Weiss' score of 6. After surgery, he was treated with adjuvant radiotherapy. Twenty-one months after treatment, the patient remains alive with no evidence of recurrence.

A Case Report of Gynecomastia Due to Rosuvastatin

Gynecomastia is a common benign disease characterized by the progressive enlargement of the glandular tissue of the male breast due to an imbalance between the levels of estrogen and androgen in the blood. The etiology may vary and may be physiological, pharmacological, pathological, or even idiopathic. Among men, drug-induced gynecomastia may account for 10% to 20% of cases. The literature contains six case reports of rosuvastatin-induced gynecomastia. Withdrawal of statin or switching to a less potent statin can lead to symptom improvement and avoidance of unnecessary tests and patient anxiety. A 62-year-old male patient developed unilateral gynecomastia after 13 months of rosuvastatin therapy. After switching to a different statin (pravastatin), his symptoms improved within 2 months. Thus, clinicians should be aware of the possibility of occurrence of gynecomastia when statins are prescribed.

Conocimientos y prácticas de médicos generales en el manejo de la ginecomastia / Knowledge and practices of gynecomastia of non-specialist's doctors / Conhecimentos e práticas de clínicos gerais no gerenciamento de ginecomastia

Introducción. La ginecomastia es un trastorno endocrinológico con alta prevalencia y morbilidad, sin documentación epidemiológica local que guíe a los médicos generales para la identificación y manejo individualizado.Objetivo. Identificar y asociar los conocimientos de los médicos generales encuestados con las prác-ticas de su ejercicio profesional cotidiano ante posibles casos de ginecomastia.Materiales y método. Estudio descriptivo de corte transversal y enfoque cuantitativo, en el que, posterior a la validación del instrumento y consentimiento informado tácito, se aplicó a una muestra poblacional de 170 médicos durante el periodo comprendido entre febrero y mayo de 2018.Resultados. El departamento de Boyacá representó el principal punto de localización geográfica de los entrevistados, la mayoría de ellos activos en los servicios de consulta externa y urgencias de insti-tuciones de salud de nivel I de atención, egresados de universidades privadas, con tiempo de ejercicio profesional inferior a 10 años. Un alto porcentaje de los encuestados acertaron en los interrogantes referidos a conceptos teóricos, y solo el 12,9%, respecto la clasificación clínica.Conclusiones. Los médicos generales encuestados recuerdan conocimientos teóricos, pero tienen visibles dificultades para su aplicabilidad práctica. Existe correlación entre el "tiempo de ejercicio pro-fesional" y la aplicación de la "técnica del examen físico de la mama ante un caso de ginecomastia", así como entre la práctica de algunas actividades médicas, el acierto en varias preguntas del saber y la universidad de egreso.

Introduction. Gynecomastia is an endocrinological disorder with high prevalence and morbidity, without local epidemiological documentation that involves general practitioners for identification and individualized management by non-specialist's doctors.Objective. Identify and associate the knowledge of general practitioners surveyed with the practices performed within their daily professional practice in the event of gynecomastia. Materials and method. It is a cross-sectional descriptive study with quantitative approach, in which after the validation of the instrument and the informed consent, it was applied in a population sample of 170 doctors during February to May 2018. Results. Boyacá department was the main point of geographic location of the interviewees, most of them active in the outpatient services and the urgencies on 1st level health care institutions, gradua-ted from private universities, with professional exercise time less than 10 years. The majority of the respondents knows concepts referred to theoretical aspects, but only to 12,9%, regarding the clinical classification.Conclusions. Non-specialist's doctors surveyed, remember the theoretical knowledge, but the di-fficulty of its practical application is visible. There is a correlation between the time of professional practice and the application of the technique of the physical examination of a case of gynecomastia, as well as the practice of some medical activities, knowledge appropriate and university of under grade studies

Introdução. A ginecomastia é um distúrbio endocrinológico com alta prevalência e morbidade, sem documentação epidemiológica local que orienta os médicos de clínica geral para identificação e manejo individualizados.Objetivo. Identificar e associar o conhecimento dos médicos clínicos gerais pesquisados, com as prá-ticas de seu exercício profissional em caso de possíveis casos de ginecomastia.Materiais e método. Estudo transversal descritivo de enfoque quantitativo, no qual, após a validação do instrumento e o consentimento informado tácito, foi aplicado a uma amostra populacional de 170 médicos no período de fevereiro a maio de 2018.Resultados. O departamento de Boyacá representou o principal ponto de localização geográfica dos entrevistados, a maioria deles ativos nos serviços ambulatoriais e de emergência das instituições de saúde de nível I, graduados de universidades particulares, com tempo de exercício profissional infe-rior a 10 anos. Um alto percentual de entrevistados acertou nas questões relacionadas aos conceitos teóricos, e apenas 12,9%, quanto à classificação clínica.Conclusões. Os médicos clínicos gerais pesquisados lembram conhecimentos teóricos, mas têm difi-culdades visíveis para sua aplicabilidade prática. Existe correlação entre o "tempo de exercício profis-sional" e a aplicação da "técnica de exame físico da mama frente a um caso de ginecomastia", bem como entre a prática de algumas atividades médicas e o acerto em diversas questões do conhecimen-to e da universidade de graduação

The round-the-clock technique for correction of gynecomastia

BACKGROUND: Gynecomastia is a common condition that can cause severe emotional and physical distress in both young and older men. Patients in whom symptomatic recalcitrant gynecomastia persists for a long time are potential candidates for surgery. METHODS: From January 2014 to January 2016, 15 patients underwent correction of gynecomastia through a single 3-mm incision at our institution. Only patients with true gynecomastia underwent surgery with this new technique. Through the small incision, sharp dissection was performed in a clockwise and counterclockwise direction describing two half-circles. Health-related quality of life and aesthetic outcomes were evaluated using a modified version of the Breast Evaluation Questionnaire (BEQ). RESULTS: The patients’ average age was 23.5 years (range, 18–28 years), and their average body mass index was 23.2 kg/m² (range, 19.2–25.3 kg/m²). One case was unilateral and 14 cases were bilateral. The weight of glandular tissue resected from each breast ranged from 80 to 170 g. No excess skin was excised. Bleeding was minimal. The mean operating time was 25 minutes (range, 21–40 minutes). No complications were recorded. All lesions were histologically benign. The patients’ average score was 3.5 (on a 5-point Likert scale) in all domains of the BEQ for themselves and their partners. CONCLUSIONS: In this study, we demonstrated the safety and reliability of a new technique that allows mastectomy through an imperceptible 3-mm incision. We obtained high patient satisfaction scores using our surgical technique, and patients reported considerable improvement in their social, physical, and psychological well-being after surgery.

Thorax masculinization in a transsexual patient: Inferior pedicle mastectomy without an inverted T scar

Transsexual individuals with gender dysphoria or gender identity disorder are rare, with a prevalence reported to range from 0.002% to 0.014%. Studies have shown that mastectomy yields significant improvements in body image and self-esteem in female-to-male transsexual patients. In patients with grade III breast ptosis, mastectomy with a nipple-areolar complex (NAC) graft is the most commonly used technique, although it has several disadvantages. In the case described herein, a bilateral mastectomy preserving the NAC in an inferior pedicle was performed. Additionally, a thin superior thoracic dermal-fat flap was preserved and eventually sutured at the previous inframammary fold, preventing an inverted T scar. This case shows the advantage of this technique for preserving the blood supply and innervation of the NAC, with a low hypopigmentation risk. Furthermore, in this technique, the patch effect does not impair the results of the NAC graft, and there is no need to use an inverted T scar that may result in thoracic feminization.

Importancia de la anamnesis exhaustiva ante una ginecomastia unilateral inexplicada en un niño / Importance of the exhaustive anamnesis to an unexplained unilateral gynecomastia in a child

La ginecomastia es el crecimiento de la mama por un desequilibrio hormonal entre estrógenos y andrógenos. Un crecimiento importante y unilateral requiere descartar patologías subyacentes. Una causa poco frecuente es la traumática, que provoca aumento de tamaño por estimulación repetida. Se presenta el caso de un niño de 6 años con ginecomastia unilateral. Se destaca como único hallazgo en las pruebas complementarias hiperprolactinemia. Rehistoriando, se detecta una continua autoestimulación mamaria manual y oral a través de mordiscos de meses de evolución. Tras el cese del estímulo, se observa la involución de la mama y la normalización de los niveles de prolactina séricos.

Gynecomastia consists of breast enlargement due to a hormonal imbalance between estrogens and androgens. Unilateral and important breast growth requires ruling underlying pathologic disorders out. Mechanical cause is uncommon, causing enlargement by repeated stimulation. We report a 6-year-old boy with unilateral gynecomastia. Hyperprolactinemia is the only abnormal finding at laboratory tests. After repeated inquiries, a continuous breast selfstimulation is detected. Its relation with gynecomastia is verified because prolactin normalizes and breast regressed in further revisions, after stopping stimulus.

Breast Lesions in Children and Adolescents: Diagnosis and Management

Pediatric breast disease is uncommon, and primary breast carcinoma in children is extremely rare. Therefore, the approach used to address breast lesions in pediatric patients differs from that in adults in many ways. Knowledge of the normal imaging features at various stages of development and the characteristics of breast disease in the pediatric population can help the radiologist to make confident diagnoses and manage patients appropriately. Most breast diseases in children are benign or associated with breast development, suggesting a need for conservative treatment. Interventional procedures might affect the developing breast and are only indicated in a limited number of cases. Histologic examination should be performed in pediatric patients, taking into account the size of the lesion and clinical history together with the imaging findings. A core needle biopsy is useful for accurate diagnosis and avoidance of irreparable damage in pediatric patients. Biopsy should be considered in the event of abnormal imaging findings, such as non-circumscribed margins, complex solid and cystic components, posterior acoustic shadowing, size above 3 cm, or an increase in mass size. A clinical history that includes a risk factor for malignancy, such as prior chest irradiation, known concurrent cancer not involving the breast, or family history of breast cancer, should prompt consideration of biopsy even if the lesion has a probably benign appearance on ultrasonography.