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.

The molecular mechanisms related to the breast cancer development are poorly understood, particularly those associated with estrogen. Evidence is mounting that developmental differences may influence the risk of cancer. However, understanding breast development, morphology and the biochemical factors that influence them is pertinent to study pre-malignant and malignant conditions that affect the breasts. Objective: To evaluate the proliferative activity of normal breast epithelium, through the c-myc expression, after the administration of combined oral hormonal contraceptive, associated or not with estriol. Retrospective double-blind study, in which the effect of combined oral contraceptives on the normal breast epithelium in women with fibroadenoma was evaluated. We analyzed 33 women In a cohort of 70 selected (37 excluded). The control group (1) received a compound containing levonorgestrel 0.15mg (LNG) and ethinylestradiol 0.03mg (EE), associated with 2mg of placebo (PLC) manufactured in the same capsule ingested daily for 21 days with an interval of 7 days, during four cycles. The study group (2) received a compound containing levonorgestrel 0.15 mg (LNG) and ethinylestradiol 0.03 mg (EE), associated with estriol 2 mg (E3) manufactured in the same capsule ingested daily for 21 days with an interval of 7 days, up to four cycles, when was proceeded the lumpectomy plus normal breast tissue sample. The UNIFESP-EPM Department of Pathology received the samples collected and fixed in 10% buffered formalin. We used an automation device to perform the Immunohistochemistry reactions, using c-myc antibodies, added DAB developer (diaminobenzidine) that provides a bright brown color that provides good contrast. We used conventional optical microscopy to read TMA slides. We considered positive the nuclei stained with dark brown in contrast to the blue negative to the c-myc reactions. We evaluated the epithelial areas at least five acinar units were present in the sample at 40X magnification. In the statistical analysis, the initial stages of consolidation as well as the analysis were performed in Software R (2020) and Rstudio (version 4.1), using the packages Tidyverse (2016), Psyco, SummaryTools, Janitor and DataExplorer. After verifying the assumptions of normality, independence and linearity, Student’s T test was performed for independent samples. An alpha of 0.05 was chosen for rejection of the null hypothesis, that is, a confidence interval of the test results of 95%. An effect size measure of the difference between the groups was also performed, called Cohen’s D; it ranges from -1 to 1, and the closer to 0, the smaller the effect size of the difference between the groups. Regarding the control group (30.30%) and the case group (69.70%). The table 2 presents the results for group 1 (COC + Placebo), while table 3 presents the results for group 2 (COC + Estriol). The T test was performed to verify a possible significant difference in the levels of cell proliferation in patients with or without Estriol. The normality was verified by the Shapiro-Wilk test, with data following a normal distribution (W = 0.901 and 0.96, p value > 0.3). The equitable variance was verified by the Levine test, which verified the equitable variance in both groups (F (1) = 0.24, p value = 0.62). A mean positive nucleus of 14 (SD = 10.65) was observed in the group of patients with contraceptive plus placebo and a mean of positive nuclei of 20.81 (SD = 9.88) in the group of patients with contraceptive plus Estriol. The ratio of positive nuclei to total was higher in the estriol group than in the control group. However, it was not possible to verify a significant difference in the two groups (T (14.57) = 1.3, p value = 0.215, d Cohen = 0.53). Cohen’s d pointed to a moderate difference effect (table 4). Table 2. Number of positive, negative and total normal epithelial cell nuclei in immunohistochemical investigation of c-myc antigens in Group 1 (COC + Placebo) (N = 10) Table 3. Number of positive, negative and total normal epithelial cell nuclei in immunohistochemical investigation of c-myc antigens in Group 2 (COC + Estriol) (N = 23) Table 4. Inferential results of the ratio of positive normal epithelial cell nuclei as a function of the control and case groups Citation Format: Osmar Pellegrini, Jr., Afonso Nazário, Angela Flavia L. Waitzberg. Assessment of the proliferative activity of breast tissue after the administration of combined oral hormonal contraceptive, associated or not with estriol [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-27.

Introduction: Gynecomastia (GM) is the benign proliferation of breast tissue in men. Its prevalence is of up to 65% according to age. It can be unilateral or bilateral. The standard surgery is periareolar incision, even though it can lead to asymmetry (AS), anesthetic scar, retraction or necrosis of the nipple-areolar complex (NAC). The vacuum-assisted excision (VAE) is the alternative approach. Objectives: To describe the technique and results of ultrasound-guided VAE for GM. Methods: series of 7 cases of Simon I and II GM, submitted to US-guided VAE (10G needle and ENCOR® BD) between December 20, 2018, and October 26, 2019. The cases were assessed considering clinical, laboratory and imaging aspects with mammography (MMG) and US. The pre-surgical consent form was obtained. US-guided VAE was performed with a 3 mm incision, in the ambulatory, with local anesthesia (2% lidocaine) and no sedation, in the “fine precision” and “dense breast” modes, in order to leave a 1cm flap in the retroareolar region. At the end, a vacuum and/or manual drainage of the cavity was performed to reduce the postoperative hematoma (HMA). In the postoperative period, MMGs were performed 1 and 6 months after the VAE, and the revisions occurred on the 7th and 14th day, and the 1st, 2nd and 6th months. The patients wore vests for 30 postoperative days. The outcomes were good or excellent when the amount of residual breast tissue was minimum, and AS, retractions, necrosis, anesthetic scar or NAC deviation, absent. The patients filled out a form of satisfaction level and perception of the VAE. Results: Mean age was 26.7 years. Mean time of VAE was 28 minutes. The main complaint regarding VAE was aesthetic discomfort, followed by physical deformity. One patient presented with areola skin tear during the procedure. It was sutured and did not impact the aesthetic result. All patients and surgeons reported excellent or sufficient levels of satisfaction. There were no recurrences or re-approach in 6 months. There was no hemorrhage in the peri or postoperative period, with no open approach. No patient required sedation. They all had histology of GM. No cases of breast deviation, necrosis or NAC retraction, infection, AS our anesthetic scar. No patient reported changes in erection or breast sensitivity. They all presented with hemorrhagic suffusion and hematoma with spontaneous resolution in 30 days, without interfering in the outcome. No intervention or hematoma drainage was necessary in the postoperative period. Conclusion: US-guided VAE for GM is alternative to the conventional surgical treatment in Simon I and II cases, with good or excellent results. It presents low complication rates and high satisfaction rates. It is performed in the ambulatory, without intercurrences. Comparative studies of traditional surgery and VAE should be performed.