Updates in Treatment of Gynecomastia
Kamal Ahmed Kamal Mohamed Omar;
Abstract
Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. Gynecomastia was reported to be due to an imbalance between estrogen and androgen action , due to increased estrogen production, decreased androgen production or both. At least 30% of males will be affected during their life. Since it causes anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important and patients usually seek medical attention.
The breast is composed of three major structures: skin, subcutaneous tissue, and breast tissue (stroma and parenchyma). Male breast is composed mainly of fat with few ducts and stroma with lack of Cooper's ligaments and lobular tissue, differentiating it from the female breast
Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery.
The goal of plastic surgery of the breast is to recreate a natural appearance that is satisfying to the patient and surgeon. Despite the fundamental nature of this outcome, breast aesthetics is poorly understood and difficult to measure.
Breast aesthetics consist of the following:
Shape, size and volume. Inframammary fold.
NAC complex. Symmetry.
Scars.
The ideal aesthetic normal male breast is typically flat with some fullness around the nipple-areola complex. The nipple-areola complex is normally 2 to 4 cm in diameter (average, 2.8 cm) and located over the fourth intercostals space at the point of maximal breast projection. The areola has a slight projection on the surrounding breast tissue, and the nipple has a more noticeable projection of approximately 3 to 7 mm.
93
Summary and Conclusion
Despite the reported successes of medical therapies in some publications, many of the study subjects went on to have surgical treatment, even after partial regression. Spontaneous regression and an effective nonsurgical treatment are only theoretically possible in types of gynecomastia. Surgical treatment remains the treatment of choice for many patients. The patient will present to the plastic surgeon based on his concerns, not necessarily based on the severity of the gynecomastia, so surgical treatment should be individualized based on patients and their desires and expectations.
Indications of Surgical Treatment
For patients given the limited efficacy of medical therapy.
Gynecomastia with clinically noticeable large lumps or asymmetry or if it is bothersome to the patient.
For cases of Simon’s grade II b and III or IV and systemic conditions have been ruled out.
If the onset has been greater than 18 months, fibrous conversion makes it unlikely to recede, regardless of etiology. Therefore, long-standing gynecomastia without pathological etiology is best treated with surgery .
The breast is composed of three major structures: skin, subcutaneous tissue, and breast tissue (stroma and parenchyma). Male breast is composed mainly of fat with few ducts and stroma with lack of Cooper's ligaments and lobular tissue, differentiating it from the female breast
Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery.
The goal of plastic surgery of the breast is to recreate a natural appearance that is satisfying to the patient and surgeon. Despite the fundamental nature of this outcome, breast aesthetics is poorly understood and difficult to measure.
Breast aesthetics consist of the following:
Shape, size and volume. Inframammary fold.
NAC complex. Symmetry.
Scars.
The ideal aesthetic normal male breast is typically flat with some fullness around the nipple-areola complex. The nipple-areola complex is normally 2 to 4 cm in diameter (average, 2.8 cm) and located over the fourth intercostals space at the point of maximal breast projection. The areola has a slight projection on the surrounding breast tissue, and the nipple has a more noticeable projection of approximately 3 to 7 mm.
93
Summary and Conclusion
Despite the reported successes of medical therapies in some publications, many of the study subjects went on to have surgical treatment, even after partial regression. Spontaneous regression and an effective nonsurgical treatment are only theoretically possible in types of gynecomastia. Surgical treatment remains the treatment of choice for many patients. The patient will present to the plastic surgeon based on his concerns, not necessarily based on the severity of the gynecomastia, so surgical treatment should be individualized based on patients and their desires and expectations.
Indications of Surgical Treatment
For patients given the limited efficacy of medical therapy.
Gynecomastia with clinically noticeable large lumps or asymmetry or if it is bothersome to the patient.
For cases of Simon’s grade II b and III or IV and systemic conditions have been ruled out.
If the onset has been greater than 18 months, fibrous conversion makes it unlikely to recede, regardless of etiology. Therefore, long-standing gynecomastia without pathological etiology is best treated with surgery .
Other data
| Title | Updates in Treatment of Gynecomastia | Other Titles | التطورات الحديثة في علاج التثدي | Authors | Kamal Ahmed Kamal Mohamed Omar | Issue Date | 2016 |
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