On the neglected entity of unilateral gynecomastia.

Although there are many articles in the literature on the etiology, classification, and management of gynecomastia, the entity of unilateral gynecomastia has not received much attention. In this article, 15 consecutive males (seen over a 10-year period) with unilateral gynecomastia were retrospectively reviewed. The study showed the unique presentation in this group of patients. One third of the patients (n = 5) had "cancer phobia" and were worried either because of the presence of a mass (n = 2) or because of the unilaterality of their disease (n = 3). The study also showed the predominance of true (glandular) gynecomastia, and this has also been observed in other cases of unilateral involvement in the literature. All patients underwent preoperative mammography. Mammographic findings were consistent with gynecomastia in all patients, including the 2 patients with concurrent breast masses. All patients underwent subcutaneous mastectomy, and histologic examination confirmed the diagnosis. Finally, the literature on unilateral gynecomastia was reviewed.

The surgical management of high-grade gynecomastia.

It is now well accepted that low grades of gynecomastia are best treated with liposuction alone. However, the surgical management of the high-grade gynecomastia (Simon's grade III) has remained problematic because both liposuction and conventional subcutaneous mastectomy (without skin excision) have frequently resulted in significant residual skin redundancy, requiring a second operation for skin resection. Our preferred approach to high-grade gynecomastia has been the single-stage subcutaneous mastectomy and circumareolar concentric skin reduction with deepithelialization. However, in the rare case of tubular breast deformity in the male and also in patients with gynecomastia who underwent massive weight loss, simple mastectomy and free nipple graft is performed. Therefore, these 2 groups of patients will be excluded from the current series. Twenty-four consecutive males with high-grade gynecomastia were reviewed. All patients underwent subcutaneous mastectomy with concentric skin resection. There were no major complications such as infection, hematoma, seroma, or nipple-areola complex necrosis. The main disadvantage of the technique was the mild residual skin redundancy, which was noted in all 24 patients. This redundancy, however, was never severe enough to require a secondary procedure, and all patients were satisfied with the final result.