Surgical Management of Gynecomastia: A Comprehensive Review of the Literature

Abstract

Summary: Gynecomastia is a graded condition characterized by enlargement of the male breast that affects a significant proportion of the male population. A plethora of varying surgical approaches currently exists in the literature; thus this comprehensive review sought to analyze surgical practice patterns and trends as they pertain to gynecomastia grade and severity. The current literature was queried utilizing the PubMed and MEDLINE databases—based on predefined parameters and individual review, 17 studies were ultimately included. Key data points included gynecomastia grade, surgical intervention, rate of complication, including hematoma, seroma, infection, and necrosis, and drain use. Two-sample t test was utilized for further analysis. A total of 1112 patients underwent surgical treatment for gynecomastia. Skin-sparing mastectomy with or without liposuction was the most frequently used procedure followed by mastectomy with skin reduction. Major complication rates ranged from 0% to 33%, with hematoma formation being most common (5.8%) followed seroma (2.4%). There was a higher rate of hematoma/seroma formation among authors who routinely utilized drain placement (9.78% versus 8.36%; P = 0.0051); however, this is likely attributable to the large discrepancy in percentage of grade III patients found in each group (50.23% versus 4.36%; P = 0.0000). As a wide variety of surgical techniques exist for the treatment of gynecomastia, an individualized approach based upon gynecomastia grade and patient preference may assist the surgeon in providing optimal outcomes. This senior author’s preferred method for treatment of gynecomastia is illustrated in the included algorithm.

NAC Plaster Lifting Technique for the Management of Skin Redundancy in Severe Gynecomastia

“…There was no revision surgery in our study. 22 The patient satisfaction rate in our study was comparable with the study conducted by Shirol et al 23…”

Ginecomastia: Consideraciones médicas y quirúrgicas en cirugía general

“…El procedimiento, generalmente conlleva a una gran satisfacción personal en la mayoría de los pacientes (84,5 % al 100 %), pero no está exenta de riesgos. En la literatura se encuentran reportes de seromas (2,4 % al 12,5 %); hematomas (5,8 %) y equimosis (10 %), a pesar de una meticulosa hemostasia (figura 7); algunos relacionados con el uso de drenajes 44,45 . Otras complicaciones reportadas son queloides (2,5 %), alteración en la sensibilidad (3 -14 %), asimetría (7 %) por redundancia de piel, necrosis de la areola o del colgajo y retracciones, hipertrofia (14 %), resección insuficiente o incompleta con persistencia glandular o recurrencia (8 %) 47 .…”

“…Se debe aclarar al paciente que el objetivo principal del procedimiento es lo funcional 20,34,40,44,45 .…”

“…Por último, se ha demostrado que el tratamiento quirúrgico para la ginecomastia en pacientes jóvenes trae efectos beneficiosos significativos en la calidad de vida, con mejoría en ámbitos de función física, salud general, vitalidad, salud mental y psicosocial. Los mejores cambios en el desarrollo hacia una mejor calidad de vida posoperatorio se obtienen en los pacientes más jóvenes, más obesos y con ginecomastia moderada a severa (grado 2 y 3) 45,46,48 .…”

Gynécomastie en pratique clinique pour les urologues

“…Cette approche peut être combiné à une liposuccion. Lors des gynécomasties plus importantes une approche chirurgicale avec excision du surplus de peau plus ou moins reconstruction par lambeau est utilisée [23][24][25].…”