Complications and Quality of Life following Gynecomastia Correction in Adolescents and Young Men

Abstract

Background: Persistent adolescent gynecomastia negatively affects health-related quality of life. Surgery results in psychosocial improvements, but the effects of postoperative complications on health-related quality of life are unknown. The authors examined whether complications following adolescent gynecomastia surgery impact postoperative health-related quality of life. Methods: Patients aged 12 to 21 years who underwent surgical correction of unilateral/bilateral gynecomastia between 2007 and 2019 were enrolled (n = 145). Relevant demographic and clinical data were obtained from medical records. Fifty-one patients completed the following surveys preoperatively, and at 6 months and 1, 3, 5, 7, 9, and 11 years postoperatively: 36-Item Short-Form Health Survey (Version 2), Rosenberg Self-Esteem Scale, and the 26-item Eating Attitudes Test. Results: Within a median period of 8.6 months, 36 percent of breasts experienced at least one complication. The most common were residual tissue (12.6 percent), contour irregularities (9.2 percent), and hematomas (7.8 percent). Patients reported significant postoperative improvements in self-esteem and in seven health-related quality-of-life domains (Physical Functioning, Role-Physical, Bodily Pain, Vitality, Social Functioning, Role-Emotional, and Mental Health) at a median of 33.3 months. Postoperative survey scores did not vary by grade or procedure, or largely by body mass index category or complication status. However, patients aged younger than 17 years at surgery scored significantly higher than older patients in the Short-Form Health Survey Vitality and Mental Health domains postoperatively. Conclusions: Health-related quality-of-life improvements are achievable in adolescents through surgical correction of persistent gynecomastia. Postoperatively, patients largely experienced similar health-related quality-of-life gains irrespective of complication status, grade, surgical technique, or body mass index category. Minor postcorrection complications are but do not appear to limit postoperative health-related quality-of-life benefits.

Gynecomastia: A systematic review of pharmacological treatments

“…They can lead to problems in interpersonal relations, social phobia or social isolation, and psychological disorders (e.g., depression, anxiety), and significant deterioration in social and academic processes. A correlation was found between the severity of the gynecomastia and the psychologic distress (2,(6)(7)(8)(9)(35)(36)(37). Mitigating psychological and social problems are the major reasons for medical intervention in PG.…”

“…In most patients, PG is transient and resolves spontaneously within 1–3 years ( 2 , 7 – 9 ). However, in some patients, gynecomastia will persist beyond 2–3 years, and these cases are often referred to surgical treatment ( 1 , 2 , 36 ).…”

“…Currently, the standard of care for patients with gynecomastia during adolescence, who are seeking treatment, is reassurance and explanation of the transient nature of their condition and the pain associated with it. Surgery is usually only considered and executed, if indicated, towards the end of puberty ( 1 , 36 ). The desired pharmaceutical therapy should be efficient and safe, fast acting, with low rate of side effects or complications.…”

“…Although gynecomastia is self-limited in most of the cases, treatment is warranted in the challenging cases when patients have a significant breast mound or suffer significant psychological distress ( 37 ). Considering all the above, once the diagnosis of PG is made, treatment with tamoxifen may be favorable ( 6 , 7 , 19 , 35 , 36 ). Therapy should be attempted.…”