Bodybuilder Gynecomastia: Etiology, Characteristics and Management.

Abstract

Background: Bodybuilder gynecomastia represent special entity, being secondary to use/abuse of anabolic steroids leading to glandular enlargement as the sole or the main underlying pathology with occasional fatty element. Typical management entails complete gland excision through the least visible scar, (typically periareolar) with preservation of pectoral muscle and fascia integrity. Adjuvant small volume liposuction is needed in some cases with fatty element.Patients and Methods: The study enrolled a series of 13 bodybuilder with gynecomastia and history of anabolic steroids use/abuse. All cases presented with glandular tissue enlargement, with fatty element noted in 4 cases. Operations were done under general anesthesia with tumescent fluid infiltration. Through inferior periareolar incision almost the whole enlarged gland was excised, with adjuvant liposuction as indicated. Meticulous hemostasis and preservation of pectoral fascia integrity aimed to minimize excessive scaring beneath a thin overlying areolar skin flap and possible subsequent adhesions and contour irregularities.Results: All cases achieved final satisfactory results with high patients satisfaction. Early complications included minor hematoma in one case. Probably this was the cause of later dynamic depression seen with pectoral muscle contraction noted at 6 months follow up and resolved spontaneously during the next year.Conclusion: Bodybuilder gynecomastia managements entailed almost complete glandular tissue excision with limited liposuction in some cases. Meticulous technique including proper hemostasis is important to avoid even the minor contour irregularities and other complications in such demanding cases seeking perfect shape.