Gynecomastia in a Filipino adolescent male: A rare forewarning sign of fibrolamellar hepatocellular carcinoma

@#We present a 15-year-old male with a two-year history of gynecomastia and a four-month history of gradually enlarging abdomen and right flank pain. Examination revealed severe stunting with breast mass Tanner Stage 3, penile stage 2, and hepatosplenomegaly. Laboratory investigations showed normal blood counts, liver function tests, alpha-fetoprotein, and beta-human chorionic gonadotropin. The imaging findings demonstrated multiple confluent masses in the liver, histologically diagnosed as fibrolamellar hepatocellular carcinoma.

Aromatase deficiency caused by mutation of CYP19A1 gene: A case report / 中南大学学报(医学版)

Aromatase deficiency (AD) is a rare autosomal recessive genetic disease caused by loss-of-function mutations in aromatase gene (CYP19A1), leading to congenital estrogen deficiency syndrome. Both mothers of AD patients during pregnancy and female AD fetus show virilization, while male patients are usually diagnosed in adulthood due to continued height increase and metabolic abnormalities. In 2019, a patient with AD was admitted in the Second Xiangya Hospital. The patient was a 37-year-old adult male who continued to grow linearly after adulthood. His estradiol was below the measurable line, the follicle-stimulating hormone (FSH) increased, bone age delayed, epiphysis unfused, and the bone mass reduced. CYP19A1 gene detection showed that c.1093C>T, p.R365W was homozygous mutation. This disease is rare in clinic. Clinicians need to raise awareness of the disease for early diagnosis and treatment to improve the long-term prognosis of patients.

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

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

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.

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.

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

Embryonal Carcinoma of the Pineal Gland Developed in an Adolescent Boy with Klinefelter Syndrome / 임상소아혈액종양

Klinefelter syndrome (KS) is characterized by small testes, gynecomastia, tall stature, and hypergonadotropic hypogonadism. This condition is associated with extra X chromosomes. It is well known that these aneuploidies predispose individuals to the development of several cancers. Moreover, there are many case reports that show KS patients to have a higher relative risk for the development of malignancy. However, incracranial germ cell tumor (ICGCT) associated with KS is very uncommon. Herein, we report delayed diagnosis of KS in a 15-year-old boy with ICGCT, embryonal carcinoma of the pineal gland, after multimodality treatment in Korea.

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.

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.

Amenorrhea as a Side Effect of Low Dose Aripiprazole: An Adolescent Case

Amenorrhea, oligomenorrhea, galactorrhoea, gynecomastia, infertility, and sexual dysfunction may arise as a consequence of hyperprolactinemia. Hyperprolactinemia is one of major side effects of treatment with antipsychotics, but aripiprazole is known as a dopamine stabilizer antipsychotic which can be used to improve hyperprolactinemia. In this report, it was described that an adolescent patient experienced amenorrhea after adding very low dose aripiprazole to ongoing fluoxetine treatment regime for major depressive disorder. Additionally, this case showed that the patient recovered from the amenorrhea with replacement of aripiprazole with quetiapine.

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.

Incisão periareolar em zigue-zague para tratamento de ginecomastias / Periareolar zigzag incision as treatment for gynecomastia

Introdução: Ginecomastia é a hipertrofia e hiperplasia benigna da mama masculina. Representa a condição benigna mais frequente da mama masculina. O objetivo é avaliar os resultados estéticos, e satisfação dos pacientes submetidos a uma nova abordagem para o tratamento da ginecomastia, com incisão periareolar em zigue-zague. Métodos: Apresentamos uma casuística de 13 casos de ginecomastia tratados com a técnica periareolar em zigue-zague. Resultados: Todos os pacientes ficaram satisfeitos com a cicatriz camuflada na transição, naturalmente irregular, da pele periareolar com o complexo aréolo mamilar. Não houve complicações na série descrita. Conclusão: A abordagem descrita é uma excelente alternativa para o tratamento das ginecomatias. Proporciona um resultado estético satisfatório, é de fácil execução e tem a vantagem de não deixar estigmas na mama masculina operada.

Introduction: Gynecomastia is a benign hypertrophy and hyperplasia of the male mammary gland, and is considered the most frequent benign condition of the male breast. The objective is to evaluate aesthetic results and satisfaction of patients undergoing a new approach using a periareolar zigzag incision for the treatment of gynecomastia. Methods: We present 13 cases of male gynecomastia treated with a periareolar zigzag incision technique. Results: All patients were satisfied with the scar hidden in the transitional, naturally irregular periareolar skin of the nipple-areolar complex. No complications were observed in this patient series. Conclusion: This approach is an excellent, easy-to-perform surgical alternative for the treatment of gynecomastia, providing a satisfactory cosmetic result without the presence of a stigmatizing scar.

Tratamiento de la ginecomastia: Diferencias entre la incisión periareolar externa y la incisión periareolar inferior en mastectomía subdérmica / Treatment for gynecomastia: Differences for the external and inferior periareolar incision for subdermal mastectomy

Introducción: La ginecomastia define el aumento benigno del tamaño de la glándula mamaria en el hombre. Existen diversos abordajes quirúrgicos para la resección de la lesión, cada una con resultados diferentes. Material y métodos; Estudio transversal. Se incluyeron pacientes con ginecomastia operados de mastectomía subdérmica mediante incisión periareolar externa e incisión periareolar inferior. Para la aleatorización se tomó en cuenta los grados IIb y III de Simon, distribuyendo uno a uno para cada tipo de incisión. Los resultados estéticos fueron evaluados por un cirujano experimentado, tomando como excelentes cuando hubo una cicatrización correcta sin deformidad del área, buenos cuando la cicatrización fue buena sin deformidad del área y mala cuando hubo deformidad del área operada. Resultados: Fueron operados 24 pacientes, el 50% por incisión periareolar externa y el 50% por incisión periareolar inferior. La edad promedio fue 25,58 y 27,58 años respectivamente, sin diferencias significativas p = 0,513. Todos los pacientes tuvieron características sexuales secundarias normales. La etiología fue idiopática en 23 pacientes (95,83%). El tiempo promedio de evolución fue 32,28 meses y en todos el resultado histopatológico fue ginecomastia. La evaluación del aspecto estético de la incisión y el área afectada en los pacientes operados mediante incisión periareolar externa (n = 12) fue mala en un paciente (8,33%), buena en 2 (16,66%) y excelente en 9 pacientes (75%), mientras que en los pacientes operados mediante incisión periareolar inferior, fue buena en el 100% de los pacientes, y mala y excelente en ningún paciente, con diferencias estadísticamente significativas para ambas incisiones, p = 0,000. Ningún paciente presentó complicaciones. Conclusión: Ambas incisiones son seguras. La incisión periareolar externa ofrece mejores resultados que la incisión periareolar inferior para realizar mastectomía subdérmica en pacientes con ginecomastia en todos los grados Simon.

Introduction: Gynecomastia defines the benign enlargement of the mammary gland in man. There are several surgical approaches for resection of the lesion, each with different results. Material and methods: Cross-sectional study. There were included patients with gynecomastia, operated by means of external and inferior periareolar incision. For randomization was took into account degrees IIb and III of Simon, distributing one to one for each type of incision, the cosmetic results were evaluated by an experienced surgeon, taking as excellent results when there was a proper healing without deformity of the area, good results when healing was good without deformity, and bad results when there was deformity of the operated area. Results: There were 24 patients, 50% operated by external periareolar incision and 50% by lower periareolar incision. The mean age was 25.58 and 27.58 years old for each group, with no significant statistically differences (P = .513). All patients had normal secondary sexual characteristics. The etiology was idiopathic in 23 (95.83%). The average evolution time was 32.28 months, on all histopathological result was gynecomastia. The evaluation of the aesthetic aspect of the incision and the area affected in patients operated by external periareolar incision (n = 12) was bad to 1 (8.33%), good in 2 (16.66%) and excellent in 9 (75%) patients; 100% of the patients operated by inferior periareolar incision presented good results, there were statistically significant differences for both incisions, P = .000. There were no complications. Conclusion: Both incisions are safe, periareolar external incision provides better results than the inferior periareolar incision for patients with gynecomastia in all degrees of Simon.