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.

Tratamiento quirúrgico de la ginecomastia. Nuestra experiencia institucional / Surgical treatment of gynecomastia: our institutional experience

La ginecomastia es la patología mamaria benigna más frecuente, evidenciándose en distintas etapas de la vida; en la mayoría de los casos, regresa en forma espontánea o por tratamiento médico; sin embargo, un porcentaje no despreciable requiere tratamiento quirúrgico, que debe realizarse de acuerdo con las características de la glándula mamaria y su entorno adiposo. Material y método: En este trabajo realizamos una revisión retrospectiva de los 47 pacientes masculinos evaluados por ginecomastia en el Hospital Naval Puerto Belgrano entre junio de 2000 y junio de 2014 inclusive, de los cuales se operaron 32. Las variables consideradas fueron: edad, ubicación de la lesión, etiología, grado según la clasificación de Simon, forma de presentación, histología y complicaciones postoperatorias. Se realizó adenomastectomía simple sin liposucción. Resultados: Se intervinieron 32 pacientes con un rango de edad de 15-77 años y un promedio de 38,9 años; la ubicación fue mayoritariamente unilateral (65,62%); la bilateralidad fue del 34,37% (11 pacientes). Las causas fueron múltiples, predominando la persistencia de la ginecomastia puberal y la secundaria a medicación crónica. La mayoría correspondió al Grado I y IIA de Simon, y las complicaciones postoperatorias estuvieron acorde a la literatura: seroma en un 10% ( 5 pacientes) y hematoma en un 4,34% (2 pacientes). Conclusiones: El tratamiento quirúrgico de la ginecomastia solo debe realizarse después de un extenso estudio del paciente para determinar su etiología y el fracaso del tratamiento médico, y debe tener como objetivo lograr un aspecto normal del tórax masculino, con la menor cicatriz posible, disminuyendo el impacto en la calidad de vida que tiene una mama feminoide en un adulto joven...

Lipólisis láser y liposucción en ginecomastia: retracción cutánea eficaz y segura / Laser-assisted lipolysis for gynecomastia: safe and effective skin retraction

OBJETIVO: Valorar la eficacia de la lipólisis-láser para corregir el volumen, flacidez y excedente cutáneo sin escisión. MÉTODOS: Prospectivamente, en 32 pacientes con ginecomastia, bajo anestesia tumescente y sedación se realizó lipólisis con láser de diodo 980nm, 15W en emisión continua, 8kJ a 12kJ de energía por mama. Externamente se utilizó aire frío para protección de la piel. Después se utilizó lipoaspiración convencional. No se emplearon drenajes pero si vendaje compresivo. Los pacientes evaluaron los resultados en una escala visual analógica. Dos médicos evaluaron los resultados por fotografías de antes y seis meses después, y midieron las areolas y contorno torácico. RESULTADOS: Veintitrés pacientes consideraron los resultados como Muy Bueno, siete Bueno y dos Regular. La retracción cutánea en la areola fue notable un mes después de la intervención y fue máxima a los seis meses. La valoración de los médicos fue 26 Muy Bueno, cinco Bueno y un Regular. No existieron quemaduras, isquemia, ni lesiones en areolas o pezón. CONCLUSIÓN: La liposucción asistida por láser es eficaz y de ejecución sencilla, poco traumática y permite una temprana reintegración a las actividades.

OBJECTIVES: To evaluate efficacy of laser lipolysis in the treatment of gynecomastia to correct breast volume, flaccidity and excess skin without its excision. METHODS: Prospectively, 32 patients with gynecomastia under tumescent anaesthesia and sedation underwent laser lipolysis with 980nm diode laser, 15W continuous emission and 8 to 12 kJ energy per breast. Externally cold air was used to protect the skin. No drainages were used but a compressive bandage. Patients evaluated results on a VAS scale. Two doctors evaluated results comparing before and 6 month after photographs and also measured the areola and chest diameter. RESULTS: Twenty three patients considered results as Very Good, 7 Good and 2 Fair Cutaneous retraction of the areola was noticeable one month after the surgery and was maximum 6 months after. Evaluation by doctors was 26 Very Good, 5 Good and 1 Fair. There were no burns, ischemia or lesions in areolas or nipples. CONCLUSION: Laser assisted liposuction is a simple and efficacious technique, barely traumatic and permits a rapid reincorporation to normal activitie.

Doença de Mondor associada à cirurgia de ginecomastia e do mamilo / Mondor´s disease associated with gynecomastia and nipple surgery", "_e": "n

A doença de Mondor é uma rara afecção, caracterizada pela tromboflebite dos vasos superficiais da região toracoabdominal, ocorrendo como uma complicação da cirurgia de mama. O objetivo deste estudo é, a partir de um caso clínico, fazer uma revisão da literatura científica sobre a doença de Mondor. O presente artigo é o relato de caso de um paciente do sexo masculino, de 38 anos de idade, portador de hipertrofia das glândulas mamárias e do mamilo direito, com prejuízos estéticos e psicológicos. Após avaliação inicial, o paciente foi submetido à ressecção parcial do mamilo direito e das glândulas mamárias por via periareolar inferior. No período pós-operatório, o paciente desenvolveu cordões dolorosos e eritematosos na região torácica inframamária bilateralmente, na topografia das veias toracoepigástricas. Os achados eram compatíveis com doença de Mondor. O paciente foi tratado com gel à base de heparina e analgésicos por via oral. Após tratamento, o paciente permaneceu com uma linha endurecida à direita. A doença de Mondor representa rara e benigna complicação da cirurgia da mama, que deve ser tratada de forma sintomática. É importante que o cirurgião esteja apto para o diagnóstico e para orientar o paciente sobre o caráter autolimitado da doença de Mondor.

Mondor's disease is a rare condition characterized by thrombophlebitis of the superficial vessels of the thoracoabdominal region that occurs as a complication of breast surgery. The aim of this study is to review the scientific literature on Mondor's disease in light of the currently reported clinical case. In this article, we describe the case of a 38-year-old man with hypertrophy of the mammary glands, which produced aesthetic and psychological effects. After an initial evaluation, the patient underwent partial resection of the right nipple and the mammary glands by inferior periareolar approach. In the postoperative period, the patient developed painful, erythematous cords in the bilateral inframammary thoracic region following the topography of the thoracoepigastric veins. The findings were consistent with Mondor's disease. The patient was treated with gel-based heparin and oral analgesics. After treatment, a hard line remained on the right side. Mondor's disease is a rare and benign complication of breast surgery that should be treated symptomatically. It is important that surgeons are able to diagnose and counsel patients about the self-limiting characteristics of Mondor's disease.

Abordagem cirurgica para o tratamento da ginecomastia conforme sua classificação / Surgical approachto the treatmanet of gynecomastia according to its classification", "_e": "n

INTRODUÇÃO: A ginecomastia é a proliferação benigna mais comum do tecido glandular da mama masculina, causada pela alteração do equilíbrio entre as concentrações de estrógeno e andrógeno. Na maioria dos casos, o principal tratamento é a cirurgia. O objetivo deste trabalho foi demonstrar a aplicabilidade das técnicas cirúrgicas consagradas para a correção da ginecomastia, de acordo com a classificação de Simon, e apresentar uma nova contribuição. MÉTODO: Este trabalho foi realizado no período de março de 2009 a março de 2011, sendo incluídos 32 pacientes do sexo masculino, com idades entre 13 anos e 45 anos. A escolha da incisão foi relacionada à necessidade ou não de ressecção de pele. Foram utilizadas quatro técnicas da literatura e uma modificação da técnica por incisão circular com prolongamentos inferior, superior, lateral e medial, quando havia excesso de pele também no polo inferior da mama. RESULTADOS: A principal causa da ginecomastia identificada entre os pacientes foi idiopática, seguida pela obesidade e pelo uso de esteroides anabolizantes. CONCLUSÕES: A técnica mais utilizada foi a incisão periareolar inferior proposta por Webster, quando não houve necessidade de ressecção de pele. Na presença de excesso de pele, a técnica escolhida variou de acordo com a quantidade do tecido a ser ressecado. A nova técnica proposta permitiu maior remoção do tecido dermocutâneo glandular e gorduroso da mama, quando comparada às demais técnicas utilizadas na experiência do cirurgião.

BACKGROUND: Gynecomastia is the most common benign proliferation of the glandular tissue of the male breast and is caused by an alteration of the balance between estrogen and androgen concentrations. In most cases, the treatment of choice is surgery. In this study, we aimed to indicate the efficacy of established surgical procedures for the correction of gynecomastia, as evaluated according to Simon's classification, and to present a novel contribution. METHODS: This study was performed between March 2009 and March 2011. It included 32 male patients, aged between 13 and 45 years. The type of incision was chosen on the basis of the need for skin resection. We used 4 techniques described in the literature and a modified procedure of circular incision with inferior, superior, lateral, and medial extensions, which we employed when excess skin was also present in the lower pole of the breast. RESULTS: Idiopathic gynecomastia was the most common etiology among our patients, followed by obesity and by use of anabolic steroids. CONCLUSIONS: The common procedure to correct gynecomastia was based on the inferior periareolar incision proposed by Webster, which we employed in patients who did not require skin resection. In the presence of excess skin, the technique chosen varied according to the amount of tissue to be resected. In the present report, we propose a novel technique that facilitates larger dermal, glandular, and fatty breast tissue removal when compared to other procedures previously used by this surgeon.

Carcinoma intraductal bilateral em adolescente de 17 anos com ginecomastia: relato de caso / Bilateral intraductal carcinoma in a 17-year-old boy

Ginecomastia é uma alteração mamária comum na adolescência, que é, geralmente, tratadacomo problema estético. O carcinoma intraductal é uma proliferação anormal de células do revestimentodo epitélio ductal da glândula mamária, não invasiva, com potencial de desenvolverinvasão. Apresentou-se o caso de um jovem de 17 anos, que se encontrava em acompanhamentohá sete anos por ginecomastia puberal bilateral idiopática. Foi submetido à exérese de glândulasmamárias bilaterais, com resultado anatomopatológico de carcinoma intraductal dos tipos sólidoe cribiforme, de baixo grau, multifocal, com margens comprometidas, em ambas as mamas. Foiencaminhado ao Serviço de Mastologia do Hospital Amaral Carvalho, em Jaú, no estado deSão Paulo, para tratamento adicional, realizando-se mastectomia simples bilateral, sem terapiaadjuvante. Após 22 meses, encontrou-se em seguimento ambulatorial sem evidência de doençaativa. Concluiu-se que o carcinoma intraductal em homens é uma patologia rara, especialmentequando bilateral e associado à ginecomastia puberal. Por essa razão, a ginecomastia não deveser subestimada, especialmente quando a regressão espontânea não ocorrer, fazendo-se semprenecessário que o cirurgião envie a glândula mamária excisada à avaliação histológica.

Gynecomastia is a common breast change during adolescence, which is generally treated as an esthetic problem.Intraductal carcinoma is an abnormal proliferation of cells lining the ductal epithelium of the noninvasive,mammary gland, with potential to develop invasion. A case of a 17-year-old boy who was monitored for sevenyears for bilateral idiopathic pubertal gynecomastia was presented. He underwent an excision of bilateral mammaryglands with pathological results of intraductal carcinoma of solid and cribriform types, low-grade, multifocal,with positive margins in both breasts. He was referred to Serviço de Mastologia from Hospital AmaralCarvalho, in Jaú, São Paulo, for further treatment, a bilateral mastectomy was performed, without adjuvanttherapy. After 22 months, he was in follow-up without evidence of active disease. We concluded that intraductalcarcinoma in men is a rare condition, especially when bilateral and associated with pubertal gynecomastia.Therefore, gynecomastia should not be underestimated, especially when spontaneous regression does not occur,making it is always necessary for the surgeon to send the excised mammary gland to the histological evaluation.

Hiperplasia ductal atípica en paciente portador de ginecomastia: caso clínico / Atypical ductal hyperplasia in a male patient with gynecomastia: case report

Atypical ductal hyperplasia (ADH) is characterized by a proliferation of uniform epithelial cells with monomorphic round nuclei filling part but not all of the involved duct. It is a known risk factor for breast cancer. We report a 16 years old male presenting with gynecomastia, which was surgically excised. The pathological study of the surgical piece revealed an ADH without evidence of infiltrating carcinoma. After 19 months of follow up, the patient is in good conditions.

Reportamos el caso de un paciente intervenido por una ginecomastia idiopática que presentó como hallazgo histológico una zona de la mama con hiperplasia ductal atípica. Se presentan sus características clinicas, y las imágenes histológicas con detalles de la pieza quirúrgica. Se revisa el tema y llama la atención la escasa ocurrencia de estos hallazgos, no habiendo en la literatura nacional casos similares publicados.

Tratamento cirúrgico da ginecomastia: uma análise criteriosa / Surgical treatment of gynecomastia: a critical analysis

Introdução: A ginecomastia é o aumento no tamanho da glândula mamária masculina, que pode ser fisiológico ou patológico, sendo condição passível de correção. Objetivo: Analisar o tratamento cirúrgico da ginecomastia, apontando suas principais complicações. Método: Duzentos e oitenta e quatro pacientes foram submetidos a cirurgia para correção da ginecomastia entre janeiro de 1998 e setembro de 2008, sendo 94,37% dos pacientes graus I e II e 5,63%, grau III. Resultados: Em relação ao total de pacientes, 3,87% apresentaram seroma e 2,11%, hematoma (p<0,001). A análise dos pacientes graus I e II revela que 0,74% apresentaram cicatrizes hipertróficas nas incisões de lipoaspiração (p<0,001). Dentre os pacientes submetidos à técnica de Davidson, 18,75% apresentaram alargamento do complexo aréolo-mamilar (p=0,108)e foram submetidos a cirurgia para correção. Conclusão: As técnicas utilizadas para correção de ginecomastia se mostraram eficazes e seguras.

Introduction: The gynecomastia is an increase in male breast and an important impact on quality of life. However, it is a condition likely to be modified. Objective: To analyze the surgical treatment of gynecomastia pointing the major complications. Methods: Two hundred and eighty-four patients underwent surgery to correct gynecomastia from January 1998 to September 2008, 94.37% of patients were grade I and II and 5.63%, grade III. Results: 3.87% patients had seromas and 2.11%, hematoma (p<0.001). Patients grade I and II had keloids in incision of liposuction (0.74%) and patients grade III presented areolar enlargement. Conclusion: The techniques used for treatment of gynecomastia were considered safe and effective with low complication rate.

Gynaecomastia; management and causative factors

To determine the causative factors and management of Gynaecomastia. Observational case series study. Surgical Unit-1 Bahawal Victoria Hospital Bahawalpur, from 1st January 200 till 31st December 2007. Thirty male patients having breast swelling were included in this study. Relevant history was obtained. Appropriate | physical examination was performed. Necessary investigations were done and after making a diagnosis appropriate treatment was done. A total of 30 patients were studied in the study period of 18 months. Those male patients who were having breast lesion other than benign enlargement [e.g. Ca. Breast, Breast/Abscess] were not included in the study. Necessary investigations were done. Subcutaneous I Mastectomy was performed. The most common age group developing gynaecomastia was of 20-30 years [60%]. Bilateral gynaecomastia was observed in 76.66% and unilateral gynaecomastia in 23.33%. Idiopathic gynaecomastia was observed in 73.33% cases. Medical treatment was given with tamoxifen 10mg twice a day for the period of three months in 6 case [20%] and this remained effective in 5 case [83.33%]. Subcutaneous mastectomy was performed in 17 cases [56.66%]. Post-operative complications were seen in 4 cases [23.52%], the most common complication being wound hematoma in 2 cases [11.76%]. Most of the patients [88.9%] were fully satisfied with the results of subcutaneous mastectomy. Gynaecomastia is the most common benign lesion of the male breast. As far as physiological gynaecomastia is concerned, patients should be observed for at least 2 years from the onset of their condition. In most of the cases spontaneous resolution occurs. Surgical treatment should be planned in whom spontaneous resolution does not occur. Surgery remains the mainstay of therapy and is frequently indicated for psychological and cosmetic reasons

Ginecomastia y pseudoginecomastia: tratamiento / Gynecomastia and pseudogynecomastia: analysis of 106 patients

Background: Gynecomastia is common among men. Pseudogynecomastia, caused by an increased subcutaneous fat in the mammary area, can be consisted with gynecomastia. Aim: To report the experience with the surgical treatment of both. Material and Methods: Review of medical records of 106 patients, aged 15 to 50 years, operated. Results: Thirty two percent of patients had a pure gynecomastia, 30 percent had pseudogynecomastia, and 39 percent had both conditions. All were mild or moderate. A mastectomy plus liposuction was performed in 50 percent of patients, solely mastectomy in 26 percent and solely liposuction in 23 percent. Four percent had surgical complications such as hematomas or ecchymoses. Conclusions: The surgical treatment of gynecomastia requires liposuction in most patients to achieve a good result.

La Ginecomastia, mamas femeninas, es la anomalía más frecuente en el sexo masculino. La pseudoginecomastia es un cuadro que a menudo se confunde con la ginecomastia y consiste en el aumento de tejido graso en la región pectoral. El equipo de cirugía plástica del Hospital Militar de Santiago, por atender una población cautiva de jóvenes que realizan el servicio militar obligatorio, ha tenido una gran experiencia en el manejo de esta enfermedad; es por esto que los objetivos de nuestro estudio fueron evaluar el manejo de los pacientes operados por esta patología en el Hospital Militar y la Clínica Santa María de Santiago, e intentar ofrecer pautas para el manejo de esta patología de la cirugía general a nivel nacional. Pacientes y Métodos: Es un estudio retrospectivo y descriptivo, realizado a 106 pacientes operados con el diagnóstico de Ginecomastia o pseudoginecomastia, atendidos entre Enero 1987 a Julio 2005 en las instituciones antes mencionadas. Resultados: Promedio de edad 24 años (rango: 15 a 50 años); 32 por ciento ginecomastia pura, 29,4 por ciento pseudoginecomastia y 38,8 por ciento ambas. Todos fueron grado I y Ha de la clasificación de Simón. En el 50 por ciento se realizó adenectomía más lipoaspiración, adenectomía sola en 26,4 por ciento y lipoaspiración exclusiva a 23,4 por ciento. Complicados un 3,8 por ciento con hematomas y equimosis. Discusión: La ginecomastia es una enfermedad frecuente en la adolescencia; además de provocar alteraciones estéticas, provoca alteraciones psicológicas en el paciente. La liposucción se consagra como una técnica quirúrgica importante a ser aplicada en esta anormalidad.

Gynaecomastia: management in a developing country

Gynaecomastia is a benign enlargement of male breast. It is common in the general population, resulting from various pathophysiological mechanisms. The aim of this study was to describe the presentation and outcome of treatment for gynaecomastia at a University Hospital in Pakistan. A three year retrospective study was carried out of one hundred men with gynaecomastia. Patients were evaluated in detail clinically and by appropriate investigations. They were counseled and kept on hormonal therapy for three months. Surgery was considered for patients with long standing gynaecomastia, failed medical therapy and for cosmetic reasons. Post operative complications and patient's satisfaction was assessed. Most [90%] cases were idiopathic. Other causes were liver cirrhosis in 4 cases, testicular tumour in two, thyrotoxicosis in one and drug induced [use of cimetidine and Kushta] in two. Carcinoma of the breast was diagnosed in one patient. Most of the patients had bilateral, non tender lump in the breast. Three cases of idiopathic gynaecomastia resolved on danazol. Eighty-eight cases underwent surgical treatment. The mean age of patients who underwent surgery [n=88] was 30.5 +/- 9.59 years. Most of the patients belonged to 21-30 years age group. Major indications for surgery were failure of medical treatment [45.5%] and cosmetic reasons [34.0%]. Mean operating time for subcutaneous mastectomy was 42.2 +/- 3.70 [36-48] minutes. Mean hospital stay after subcutaneous mastectomy was 5.2+2.44 [2-10] days. The only postoperative complication noted was wound infection [24%]. Seventy -two [81.8%] were satisfied with the results of their surgical treatment. Gynaecomastia is the common condition affecting male breasts and most common cause of gynaecomastia is idiopathic. Secondary gynaecomastia may regress in size by treating the primary cause. Idiopathic gynaecomastia do not respond to danazol so they needed surgical treatment. Subcutaneous mastectomy through a periareolar skin incision is a valid procedure for treatment for gynaecomastia and provides satisfactory cosmetic and provides satisfactory cosmetic results

Análise comparativa da técnica da incisão em duplo círculo com as técnicas com incisão periareolar e transareolomamilar de correção cirúrgica da ginecomastia / Comparative analysis of the double-circle incision and techniques with periareolar and transareolopapilar incision for the surgical correction of gynecomastia

OBJETIVO: comparar a técnica da incisão em duplo círculo (DC) com as técnicas de incisão periareolar (PA) e transareolomamilar (TAM), na correção da ginecomastia. MÉTODOS: foram revisados os prontuários de 34 pacientes com ginecomastia submetidos à correção cirúrgica no Hospital das Clínicas de Goiânia de 1999 a 2004. Os pacientes foram divididos em três grupos, de acordo com a técnica cirúrgica utilizada. Comparamos as variáveis numéricas paramétricas usando o teste de Tukey. Para as variáveis nominais, foi utilizado o teste do chi2, ou o teste exato de Fisher, quando necessário. Considerou-se significante o p<0,05. RESULTADOS: a média de idade dos pacientes foi de 27,9 (+12,5) anos. Foram operadas 43 mamas: 34 unilaterais (79,1 por cento) e nove (20,9 por cento) bilaterais; 19 (44,2 por cento) pelo DC; 14 (32,6 por cento) com incisão PA; 10 (23,3 por cento) com incisão TAM. A média do tempo de utilização de dreno foi de cinco dias para o DC e um dia para as demais (p<0,01). Foram utilizados drenos de sucção 19 vezes (100 por cento) para o DC e duas vezes (22 por cento) na transareolomamilar. Nas outras, utilizaram-se drenos de Penrose (p<0,01). O tempo cirúrgico foi significativamente maior para o DC (73 minutos) que para a PA (45 minutos) e a TAM (48 minutos). O DC foi utilizado principalmente em ginecomastias mais volumosas (p=0,04). Quanto às complicações foram observados: três casos de hematomas com a TAM (33,3 por cento) e um hematoma (5,3 por cento) com o DC (p<0,01); houve um caso de infecção com a TAM (11,1 por cento); duas necroses parciais do mamilo com a DC (10,5 por cento); quatro (21,1 por cento) cicatrizes alargadas e três (15,8 por cento) cicatrizes hipertróficas com o DC (p=0,04); uma inversão do mamilo com o TAM (2,4 por cento). CONCLUSÕES: a técnica do DC é uma boa opção para correção de ginecomastias volumosas, embora exija maior tempo cirúrgico e apresente mais cicatrizes alargadas.

PURPOSE: to compare the double-circle (DC) technique to other techniques, with periareolar (PA) and transverse nipple-areolar (TNA) incisions, for the surgical correction of gynecomastia. METHODS: we studied the medical files of 34 patients from the Federal University of Goiás, submitted to the surgical correction of gynecomastia, from 1999 to 2004. Patients were divided according to the surgical technique used. The parametric numeric variables were compared by Tukey test. The chi2 or the Fisher's exact test was used for nominal variables. It was considered significant a p value<0.05. RESULTS: the mean age of the patients was 27.9 (+12.5) years. There were 43 gynecomastias, 34 unilateral (79.1 percent) and nine (20.9 percent) bilateral. There were 19 breasts operated (44.2 percent) using DC, 14 (33.6 percent) using PA incision, and 10 (23.3 percent), TNA incision. The mean drain usage was five days for DC and one day for the others (p<0.01). The suction drain was used in 19 cases (100 percent) of DC and two (22 percent) in TNA. The other patients used drains of Penrose (p<0.01). The mean surgical time was significantly larger for DC (73 minutes) than for PA (45 minutes) and for TNA (48 minutes). DC was used mainly in voluminous gynecomastias (p=0.04). The complications consisted in three (33 percent) hematomas in TNA (p<0.01) and one (5 percent) in DC; one (11 percent) infection in TNA; two (10 percent) partial necrosis of the nipple in DC; four (21 percent) enlarged scars in DC (p=0.04); three (16 percent) hypertrofic scars (p=0.08) in DC; one (2 percent) inversion of nipple with TNA. CONCLUSIONS: The DC was used often in voluminous gynecomastias. It was a good and secure operation, although it required a more extensive surgical time and had a larger possibility of distended scars.

Ginecomastía: aproximación clínica y terapeútica / Gynecomastia: clinical and therapeutic approach

La Ginecomastia es una condición frecuente especialmente en la pubertad y edad adulta, no obstante en ocasiones produce en el paciente un importante grado de ansiedad y discomfort social. Si bien la mayoría de las veces no representa un desafío clínico diagnóstico, puede ser la manifestación inicial de un gran numero de condiciones médicas de mayor importancia para el pronóstico del paciente. De capital importancia es el diagnóstico diferencial con el cáncer de mama masculino, que si bien es de presentación mas bien excepcional, puede ser resuelto con un tratamiento precoz. El presente articulo es una revisión de los aspectos más trascendentes a considerar en el enfrentamiento clínico y terapéutico de esta condición.

Male breast disorders in Jordan. Disease patterns and management problems

To highlight the features and management problems of male breast disorders in an eastern country such as Jordan. Data regarding 33 male patients who underwent surgery for breast diseases in the Department of Surgery at Jordan University of Science and Technology, Irbid, Jordan, between the year 1996 and 2002 were analyzed. Gynecomastia [45.5%], ductal carcinoma [18.2%], and lipoma [12.1%] were the most frequent lesions. Endocrine testing when the clinical diagnosis was physiologic gynecomastia was not yielding. Many features of male breast carcinoma in Jordan [symptomatology, male to female ratio, high education rate, age, diagnostic yield of fine-needle aspiration, histological type, and estrogen receptor status] did not depart from the experience of others. Delayed presentation is evident from the fact that 57% of tumors were stage III. Loco-regional control was achieved by modified radical mastectomy. Tamoxifen was used in 5 patients, and chemotherapy in 4 patients. The patient with stage I is still disease free 6 years after the diagnosis. The 5-year survival rate for stages II and III was zero. Rare lesions [cystic hygroma, cystic mastopathy, fibroadenoma, duct papilloma, tuberculosis, periductal mastitis, and the previously unreported primary primitive neuroectodermal tumor of the breast] accounted for the rest of the group. The patient with primary primitive neuroectodermal tumor of right breast was treated by mastectomy and adjuvant chemotherapy. He remains disease free 31 months after the diagnosis. Unawareness and the fact that male breast enlargement is considered a social stigmata are responsible for the delayed presentation. The value of fine needle aspiration cytology and mammography is not widely appreciated. The wide spectrum of potential pathologies calls for referring all patients to specialized breast units

Cirugía de acceso mínimo para ginecomastia: shaver-lipoaspiración / Minimal access surgery for gynecomastia: shaver-lipoaspiration

La ginecomastia es una patología de alta incidencia, que puede causar un serio deterioro en la calidad de vida y problemas psicológicos. Etiológicamente pueden dividirse en fisiológicas, patológicas, por medicamentos e ideopáticas, representando estas últimas las más frecuentes. En cuadros de larga evolución la cirugía es el tratamiento de elección. Las técnicas escisionales son las más difundidas, resecándose el tejido glandular a través de un acceso periareolar o transareolar. La lipoaspiración es un recurso complementario, para mejorar el contorno. Este enfrentamiento no está exento de complicaciones. Se presenta una nueva alternativa terapéutica para el manejo quirúrgico de ginecomastias mediante el shaver y lipoaspiración. Se analiza la técnica, presentandose los resultados de 5 pacientes tratados de esta menera, discutiéndose posteriormente algunos puntos de interés en relación a esta patología.