Study of Different Recent Modalities for Management of Gynecomastia

Abstract

Gynecomastia is the most common disorder of male breast. According to the American Society of Plastic Surgeons, gynecomastia is usually a transient phenomenon and is considered a normal part of male adolescence.

Gynecomastia may be Idiopathic; Physiological, Pathological gynecomastia and drug induced gynecomastia. Glandular proliferation of the male breast was due to an alteration in the estrogen/testosterone (E/T) ratio. Diagnosis and evaluation needs careful history taking, physical examination and investigations; General examination of the abdomen, thyroid gland and testicular examination should be done; Local examination of breasts, nipple-areola complex, skin redundancy and axillary lymph nodes; Investigations should be limited and individualized to address abnormalities identified in the history and physical examination; Certain defined finding should prompt further evaluation, these include: FNAB, mammography, breast ultrasound and hormonal assay. There are several classifications of gynecomastia. That of Simon, is most widely known. Described by Hoffman, Simon and Kahn, classified patients into three categories, it is the commonly used classification. Other classifications depending on morphological, etiological and clinical data was described as Webster classification in 1934, Geschikter and Copeland in 1943, Letterman and Schuster in 1969, The American Society of Plastic Surgeons® (ASPS®)2002, More recently Rohrich, classification 2003 and Morphological classification. There are different modalities for treatment of gynecomastia. The majority of the patients do not require treatment, but only reassurance that their condition is not malignant. Pharmacological gynecomastia will often respond to modification or elimination of the medication regimen, metabolic gynecomastia may be treated with restoration of proper nutrition. Surgical treatment remains the treatment of choice for many patients. Excisional surgery in gynecomastia aimed at removal of glandular tissue and reduction of excess skin keeping the viability of nipple areola complex but with high rate of complications as Bleeding, hematoma, Nipple-areola or skin necrosis and deforming scars Liposuction can be used as an additional technique for optimizing the aesthetic result following the excision of the glandular tissue. It makes glandular tissue excision easier, there is better hemostasis due to a hypercoagulable state that is induced by lipoplasty, and it allows for contouring of the periphery and stimulates skin contraction. I also provide shorter operating times, a lower complication rate and minimal scars. There are many techniques of liposuction as: Suction-assisted liposuction (SAL), Ultrasound-assisted liposuction (UAL), Power-assisted liposuction (PAL), Radiofrequency-assisted liposuction (RFAL) and Laser assisted liposuction Radiofrequency-assisted liposuction (RFAL) is the most recent technique of liposuction with fewer complication rate. There are many minimal invasive techniques which are used for removal of glandular tissue of gynecomastia as the microdebrider. In a recent report the use of a power-assisted endoscopic cartilage shaver has been described for the treatment of fibrous gynecomastia.