Forms Of Gynecomastia Research Articles

ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ГИНЕКОМАСТИИ

Background. Gynecomastia (female breasts) has been known for a long time, but only in the last decades of the last centurythe problem of gynecomastia became widespread not only in endocrinology, but also in surgical practice. Most often surgical treatment is performed at stages II–III of the disease. Purpose. Is to evaluate the long-term results of surgical treatment of gynecomastia. Materials and methods. The study included 73 patients between the aged of 28 to 62 years with various stages and forms of gynecomastia. Results. No relapses were noted in all patients who underwent sectoral removal of glandular tissue and breast resection with transposition of the nipple-areolar complex. All relapses occurred after liposuction. Conclusion. The standard gynecomastia surgery and surgery for breast resection and skin ptosis with the transposition of the nipple-areolar complex showed good relapse-free long-term results.

Дифференциальная рентгенодиагностика липомастии, гинекомастии и рака молочной железы у мужчин

Background: With the growth in the equipment clinics with modern diagnostic equipment is increasing the detectability of male breast pathology. In this connection there is a need to determine X-ray characteristics of some forms of the male breast pathology especially breast cancer, because in Russia it stills a problem of detecting male breast cancer at early stages. Purpose: To determine the diagnostic capabilities of chest CT to detect various pathologies of the male breast and to identify the statistically significant radiological symptoms for the differential diagnosis of pseudogynecomastia, gynecomastia and breast cancer. Material and methods: 150 chest CT of men who were screened and treated for the various diseases in the Voronezh Regional Clinical Diagnostic Center and Kursk Regional Clinical Hospital in 2013–2015. X-ray examinations (13 chest CT, 4 PET-CT and 16 mammography) of 31 male patients with breast cancer who were surgically treated at the Voronezh Regional Oncology Hospital in 2010–2016 are presented. Results: The obtained data on the prevalence of pseudogynecomastia and gynecomastia in men who have no presenting complaints about changes in breast. Determined the forms of gynecomastia in this group of patients. Identified radiographic signs that allow a differential diagnosis between gynecomastia and breast cancer. Conclusions: 1. Gynecomastia is a common pathology of the male breast diagnosed by chest CT, and was diagnosed in 68.7 % of patients, who have no presenting complaints about changes in breast. In 96.1 % of cases, gynecomastia had a dendritic form. Diffuse glandular and nodular were rare forms of the disease and were respectively 2.9 % and 1 % of all cases of this disease. 2. Statistically significant signs of malignant character of breast masses in men were: a) the connection of the tumor with skin, areola or nipple in the form of «track» to them, thickening of the skin, «pulling» of the skin or nipple to neoplasm or their immediate invasion by tumor; b) tumor invasion into the pectoralis major muscle; c) presence of microcalcifications in neoplasm; d) presence of pathologically altered axillary lymph nodes. The determination of these radiological symptoms require immediate consultation of an oncologist. 3. Statistically significant signs of the benign character of breast masses in men were: a) bilateral lesion and the symmetry of the changes in the breasts; b) adipose tissue inclusions in breast masses. When detection gynecomastia it needs the consultation of urologist, endocrinologist, oncologist. 4. Awareness of physicians and radiologists on the possibility of developing breast cancer in men and the knowledge of the symptoms of this disease is crucial to detect male breast cancer at early stages and, as a consequence, more successful treatment and a favorable prognosis.

Gynecomastia and Tuberous Breast: Assessment and Surgical Approach

We read with great interest the article published by Cannistra et al. [1] about gynecomastia with severe ptosis and its treatment. We would like to point out that some forms of gynecomastia do not match properly the existing classifications [2–4]. Tuberous breast deformity can be associated with gynecomastia, with the same features as the corresponding condition in females. We suggest considering this a separate entity in male patients and we propose a specific surgical procedure. From January 2005 to January 2008 we treated six patients with gynecomastia and tuberous breasts using our technique. We combined traditional liposuction by the tumescent technique, standard maneuvers to reduce skin and gland excess, and gland redraping. About 50 ml of saline solution and 10 ml mepivacaine 2% with epinephrine 1:100,000 was injected via a 2-mm incision in the inferoexternal quadrant. Liposuction using a 2-mm blunt cannula was performed beneath the entire mammary region. A concentric circle entirely around the areola was deepithelized. A semicircular, infra-areolar incision of the dermis was made, leaving a superior dermal pedicle to the nipple-areola complex. A cone-shaped mass of breast tissue beneath the areola was resected. As with female tuberous breasts, the constricted base was released with electrocautery and radial incisions of the residual breast fibrous tissue beneath the areola were made. After hemostasis, a suction drain was placed laterally. An intradermal purse-string peripheral suture allowed areolar repositioning. Compressive elastic dressing was used to prevent seroma or hematoma. Elastic garments were kept on for 2 weeks postoperatively. At 1-year follow-up the cosmetic appearance was excellent in all patients (Fig. 1). Appropriate diagnosis is essential for treatment. Our studies on tuberous breasts in female patients suggest that

Treatment of Muscular Pseudogynecomastia with Botulinum Toxin A

The appearance of a female breast in men, known as gynecomastia, may raise important aesthetic and psychological issues. Webster [11] classified gynecomastia into three forms (glandular, fatty, and mixed), whereas Simon et al. [10] classified it into four categories according to the size of the gynecomastia and the presence or absence of skin redundancy. A diagnostic algorithm is suggested that emphasizes a comprehensive history and physical examination, and minimizes unnecessary diagnostic testing [9]. Two possible surgical approaches can be used to treat these forms of gynecomastia: liposuction and adenomammectomy, which eventually are combined [4,9 11]. However, the classifications and described treatment methods do not take into account a possible form of pseudogynecomastia attributable to hypertrophy of the pectoralis major muscles. This form is particularly evident in body builders, with the pectoralis major muscles progressively enlarging due to hypertrophy of muscle fibers. This form of gynecomastia also may be evident in thin individuals who practice nonagonistic sports. In most cases, this is a desired and appreciated aspect, but it may be unpleasant for some individuals reporting a breast with a female appearance. In this situation, consultation with a plastic surgeon may be requested.

Does prophylactic breast irradiation prevent antiandrogen-induced gynecomastia? Evaluation of 253 patients in the randomized Scandinavian trial SPCG-7/SFUO-3. Widmark A, Fossa SD, Lundmo P, Damber JE, Vaage S, Damber L, Wiklund F, Klepp O, Department of Oncology, Umea University, Umea, Sweden: Urology 2003;61:145–151

Objectives To examine the development of antiandrogen-induced gynecomastia and breast tenderness in the first 253 patients in a randomized Scandinavian trial (SPCG-7/SFUO-3) with a 12 month complete follow-up evaluation performed by both doctors and patients. Methods In this study, the treating doctor and patient decided whether prophylactic irradiation (RT) of the breast should be given to prevent antiandrogen-induced gynecomastia. At each visit, the doctor evaluated the occurrence of gynecomastia and breast tenderness. Questions about gynecomastia and breast tenderness were also included in the study quality-of-life questionnaire (Prostate Cancer Symptom Scale). Results Mammary RT with mostly single fraction (12–15 Gy) electrons was given to 174 (69%) of the 253 evaluated patients. At the 1-year follow-up visit, the doctor evaluations indicated some form of gynecomastia in 71% and 28% ( P < 0.001) of the nonirradiated (no-RT) and irradiated (RT) patients, respectively. The patient evaluations at 1 year showed some form of breast enlargement in 78% and 44% ( P < 0.001) of the no-RT and RT patients, respectively. The doctors reported some form of breast tenderness at 1 year in 75% and 43% ( P < 0.001) of the no-RT and RT patients, respectively. The patient evaluations of breast tenderness show an expected significant increase in the RT arm at the 3-month follow-up, which was probably because of skin reactions. At 1 year, significantly more patients who marked “very much” on the Prostate Cancer Symptom Scale were seen in the no-RT group. A weak correlation between the doctors’ and patients’ detection of breast problems was observed. Conclusions The results show that, with high significance, prophylactic RT of the breast decreases the risk of antiandrogen-induced gynecomastia and breast tenderness.

Does prophylactic breast irradiation prevent antiandrogen-induced gynecomastia? Evaluation of 253 patients in the randomized Scandinavian trial SPCG-7/SFUO-3

Objectives To examine the development of antiandrogen-induced gynecomastia and breast tenderness in the first 253 patients in a randomized Scandinavian trial (SPCG-7/SFUO-3) with a 12-month complete follow-up evaluation performed by both doctors and patients. Methods In this study, the treating doctor and patient decided whether prophylactic irradiation (RT) of the breast should be given to prevent antiandrogen-induced gynecomastia. At each visit, the doctor evaluated the occurrence of gynecomastia and breast tenderness. Questions about gynecomastia and breast tenderness were also included in the study quality-of-life questionnaire (Prostate Cancer Symptom Scale). Results Mammary RT with mostly single fraction (12 to 15 Gy) electrons was given to 174 (69%) of the 253 evaluated patients. At the 1-year follow-up visit, the doctor evaluations indicated some form of gynecomastia in 71% and 28% ( P <0.001) of the nonirradiated (no-RT) and irradiated (RT) patients, respectively. The patient evaluations at 1 year showed some form of breast enlargement in 78% and 44% ( P <0.001) of the no-RT and RT patients, respectively. The doctors reported some form of breast tenderness at 1 year in 75% and 43% ( P <0.001) of the no-RT and RT patients, respectively. The patient evaluations of breast tenderness show an expected significant increase in the RT arm at the 3-month follow-up, which was probably due to skin reactions. At 1 year, significantly more patients who marked “very much” on the Prostate Cancer Symptom Scale were seen in the no-RT group. A weak correlation between the doctors’ and patients’ detection of breast problems was observed. Conclusions The results show that, with high significance, prophylactic RT of the breast decreases the risk of antiandrogen-induced gynecomastia and breast tenderness.

Tratamento cirúrgico da ginecomastia com pedículos lateral e medial

Ginecomastia é o aumento da mama masculina que pode acometer até 65% dos indivíduos deste sexo na fase infanto-puberal, compreendida entre 13 e 16 anos. Tem como principais causas hepatite ou cirrose hepática, carcinoma ou doenças inflamatórias pulmonares crônicas, carcinomas ou disfunções testiculares, tumores glandulares (pituitária, supra-renal), alterações dos níveis séricos de testosterona, síndromes genéticas (síndrome de Klinefelter, p.ex.), uso de drogas como heroína, maconha ou anabolizantes e hanseníase. Podemos classificar a ginecomastia quanto ao volume, quanto aos tecidos que a compõem (gordurosa ou pseudoginecomastia, glandular e mista), ou quanto ao tratamento necessário para sua correção cirúrgica (pequena, moderada e grave). O tratamento das formas mais graves de ginecomastia é muito diferente daquele aplicado às formas mais suaves, pois nas formas graves, além da ressecção dos tecidos gorduroso e glandular, existe a necessidade de ressecção da pele em excesso e o reposicionamento do complexo aréolo-mamilar. O objetivo deste trabalho é descrever uma técnica cirúrgica específica para estes pacientes portadores de formas graves de ginecomastia, através de dois pedículos dermogordurosos, um lateral e um medial, com aproximadamente 2cm de espessura, mantendo assim a nutrição do complexo aréolo-mamilar. Esses pedículos são delimitados entre as bissetrizes dos quadrantes súpero-lateral e ínfero-lateral, e súpero-medial e ínfero-medial, tendo o mamilo como vértice. Na área de pele excessiva periareolar, obtida através do pinçamento interdigital, é realizada a desepidermização dos pedículos lateral e medial e ressecção de toda pele e tecido celular subcutâneo até a fáscia peitoral nas regiões superior e inferior aos pedículos; a síntese é realizada em dois planos, sendo periareolar a cicatriz resultante. Foram operados com esta técnica vinte pacientes com forma grave de ginecomastia, com média etária de 23,3 anos; sendo seis pacientes da raça negra. O bom posicionamento do complexo aréolo-mamilar e uma cicatriz periareolar resultante, bem como a retirada de conteúdo suficiente, foram as principais vantagens observadas. Como complicações, tivemos assimetria das placas aréolo-mamilares em dois casos, nos quais havia acentuada diferença entre os dois lados na avaliação pré-operatória; cicatrização hipertrófica em um paciente da raça negra, cuja cicatriz foi atenuada com injeções intracicatriciais de triancinolona; necrose parcial de aréola em um caso, cuja ferida cicatrizou por segunda intenção, dispensando qualquer tratamento local posterior; deiscência de sutura periareolar em um caso, no qual foi feita a ressutura, com bom resultado, e quatro pacientes apresentaram coleção sero-hemática subcutânea, que foram drenadas e não apresentaram recidiva.

Inferior pedicle reduction technique for larger forms of gynecomastia

Inferior pedicle reduction technique for larger forms of gynecomastia

Androgen receptor characteristics in skin fibroblasts from men with pubertal macromastia.

Endocrine studies in men with pubertal macromastia (PM) have failed to reveal a hormonal abnormality to account for the disorder. As a result, it has been hypothesized that this form of gynecomastia may be a manifestation of a target organ abnormality. Because the syndromes of apparent androgen resistance, such as testicular feminization and Reifenstein's Syndrome, are associated with gynaecomastia, we examined skin fibroblasts cultured from men with pubertal macromastia for androgen receptor defects. We studied 12 men with PM and confirmed that plasma concentrations of testosterone, oestradiol, gonadotrophins, and prolactin, were all within the normal range; findings identical to those of a similar series of patients previously reported. Androgen receptor content (R0) and binding affinity (Kd) in cultured areolar and pubic skin fibroblasts were measured using a dispersed, whole cell assay. Nineteen areolar cell lines from the 12 patients with PM were compared with 4 areolar cell lines from three normal men and 9 areolar cell lines from nine normal women. There was no difference in the mean androgen receptor content (approximately 10 000 sites/cell) or binding affinity (approximately 1 nM) between the patients' fibroblasts and those of the normal subjects. Similarly, there were no differences in these parameters when pubic skin fibroblast androgen receptors were used for the comparison. We conclude that, although PM may yet be due to a defect in breast tissue sensitivity to androgen, the disorder cannot be explained by abnormalities in fibroblast androgen receptor number or affinity.

Gynecomastia After Cytotoxic Therapy for Metastatic Testicular Cancer

Four men with metastatic nonseminomatous testicular cancer, who had received combination chemotherapy, experienced transient gynecomastia. Serum hormone levels were measured during and after the resolution of the gynecomastia. These levels indicated toxic effects on Leydig's cells and germinal epithelium concurrent with raised serum estradiol levels in the absence of tumor. The gynecomastia may have been caused by Leydig's cell dysfunction or refeeding after substantial weight loss. This benign form of gynecomastia must be recognized to avoid unnecessary investigation and treatment.