RECENT TRENDS IN SURGICAL TREATMENT OF GYNECOMASTIA

Abstract

Gynecomastia is usually a transient phenomenon and is considered a normal part of male adolescence. It can occur in persons of any age. The incidence of gynecomastia has been shown to vary widely with age. The most common form of gynaecomastia is idiopathic gynaecomastia either as persistent pubertal or late onset forms in young adult males. Physiological gynecomastia is most often defined as symptomless gynecomastia occurring in three periods of a man’s life: Neonatal, pubertal, or involutional. A number of pharmacologic agents can also result in clinically significant gynecomastia. These medications either produce estrogen like activity or inhibit the action or synthesis of testosterone. The histopathological aspect of gynaecomastia is determined not only by the pathogenesis but also by its persistence. The three types represent the stages of evolution of the pathology: in the majority of cases, after duration greater than 1 year, hypertrophic breast tissue becomes irreversibly fibrotic. For this reason medical treatment usually has limited success. gynecomastia has long been considered the result of an imbalance between these hormones. Glandular breast tissue is known to be estrogen sensitive, and any perturbation of the E/T ratio will affect cellular proliferation. Depending on the cause and duration of these hormonal changes, this condition may revert spontaneously or may require medical management or surgical intervention. Several classifications are used for gynaecomastia to define the choice of surgical technique. Simon’sclassificationin1973, described by Hoffman and Simon, classified patients into three categories based on morphology and degree of skin redundancy. It is the commonly used classification. It offers a simple guideline for diagnosis and management of gynaecomastia. The clinical grade of gynaecomastia was based on Simon’s classification.