Mastectomy for adolescent gynecomastia associated with lower risk of incident psychiatric diagnosis.

Insurance coverage for surgical correction of adolescent gynecomastia remains highly variable. This study defines the rate of preauthorization denials and identifies patient and payer characteristics associated with denials. Secondary objectives include quantifying treatment rates among those denied coverage and characterizing reasons for denials. A retrospective review was performed of all pediatric patients evaluated for gynecomastia at the Children's Hospital of Philadelphia between January 2011 and June 2024. Demographic, clinical, insurance, and preauthorization data were collected. Multivariable logistic regression was used to identify predictive factors for denial and out-of-pocket payment. Among 360 patients, the mean age at the first visit was 16.3 years (SD 2.0), with a mean gynecomastia duration of 4.2 years (SD 2.7). Most had Grade 2 (n = 146, 40.8%) or Grade 3 (n = 104, 29.1%) gynecomastia. Of the 282 patients (78.3%) who pursued treatment, 66 (23.4%) received preauthorization from their primary insurance, 11 (3.9%) were approved through secondary coverage, and 205 (72.7%) were denied or offered out-of-pocket pricing. Denials often resulted from contract exclusions due to cosmetic classification (n = 99, 45.8%); however, 31 denials (14.4%) cited insufficient documentation. On multivariable analysis, approval was associated with Public Insurer A coverage (OR = 100.5, P < 0.001). Bilateral disease was associated with decreased odds of approval (OR = 0.1, P < 0.01) relative to unilateral disease. Of the 207 patients (57.5%) who underwent surgery (n = 137, 66.2%) paid out-of-pocket, with 85.6% of these opting for lower-cost adult facilities. Black patients (OR = 0.4, P = 0.01) were less likely to self-pay relative to White patients. Insurance coverage for adolescent gynecomastia is primarily restricted by policy-level exclusions rather than clinical factors, resulting in high denial rates and frequent reliance on self-pay options. These trends, along with observed racial differences in self-payment, underscore the need for standardized, evidence-based coverage criteria to address barriers to surgical access.

&lt;b&gt;Introduction:&lt;/b&gt; Adolescent gynecomastia is a common benign enlargement of male breast tissue that may cause significant psychosocial distress. Persistent cases often necessitate surgical intervention. This study aimed to evaluate clinical features, surgical techniques, outcomes, complications, and patient satisfaction in adolescents undergoing gynecomastia surgery at a single center. &lt;br&gt;&lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The present study was undertaken to retrospectively analyze the clinical characteristics, surgical techniques utilized, treatment outcomes, complications, and patient satisfaction following surgical management of gynecomastia in adolescent boys treated at a single surgical center for the macro-region of western Poland between 2000 and 2025. The study also aimed to identify factors associated with treatment results to improve and individualize patient care in this population. &lt;br&gt;&lt;br&gt;&lt;b&gt;Methods:&lt;/b&gt; A retrospective observational study analyzed data from 26 boys aged 10-17 years who underwent surgical treatment for unilateral or bilateral gynecomastia between 2000 and 2025 at the Clinic of Pediatric Surgery, Traumatology, and Urology, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences. Surgical management primarily involved periareolar excision of glandular tissue, with selective liposuction or skin resection based on severity. Collected data included demographics, gynecomastia laterality, operative times, histopathology, complications, and patient satisfaction (5-point Likert scale). Statistical analyses included descriptive statistics, t-tests, Mann-Whitney U tests, chi-square tests, and Spearman correlation. &lt;br&gt;&lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Bilateral gynecomastia was predominant (77%), with a median age at surgery of 16 years. Mean operative time was longer for bilateral procedures (58.5 min) than for unilateral ones (38.3 min). Histopathology confirmed benign glandular tissue in most cases. Postoperative complications were rare (11.5% hematomas; one transfusion), and no reoperations were required. Overall satisfaction was high (median 4/5), though older adolescents reported slightly lower satisfaction (Rs = -0.395, p = 0.046). &lt;br&gt;&lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Surgical management of adolescent gynecomastia is safe, effective, and associated with high patient satisfaction. Bilateral cases require longer operative times, but complication rates remain low. Individualized preoperative planning, including weight optimization and age-appropriate counseling, enhances cosmetic and psychosocial outcomes. These results support timely surgical intervention in adolescents with persistent gynecomastia causing aesthetic or psychological concerns.

Gynecomastia (GYN), the most prevalent benign breast condition in men, is primarily driven by an estrogen-androgen imbalance, which induces glandular proliferation and adipose hypertrophy. This imbalance leads to the proliferation of mammary gland tissue and hypertrophy of adipose tissue. Endocrine-disrupting chemicals (EDCs), as a class of exogenous substances widely distributed in the environment, can disrupt hormonal homeostasis by mimicking estrogen, antagonizing androgens, or interfering with hormone metabolism. Consequently, they represent a significant environmental risk factor for inducing male breast development. Some evidence also suggests that gynecomastia may represent a chronic, non-infectious inflammatory response to estrogenic stimulation, which could further alter the tissue's hormonal sensitivity. This paper systematically reviews typical EDCs associated with male breast development, including bisphenols, phthalates, and polycyclic aromatic hydrocarbons. It examines their exposure pathways and mechanisms of action, analyzes the clinical characteristics, public health implications, and current prevention and control status of gynecomastia. The review highlights existing issues in current research, such as unclear mechanisms and the complexity of mixed exposure effects. It proposes that future efforts should focus on strengthening research into the molecular mechanisms linking EDCs to male breast development, improving population exposure monitoring systems, and refining prevention and control strategies. This will provide a theoretical basis for the scientific prevention and clinical management of the condition. Furthermore, the paper emphasizes the critical importance of strictly controlling the environmental release of EDCs to protect public health.

Liposuction reduces surgical time for mastectomy in gynecomastia.

Pubertal gynecomastia is associated with psychosocial consequences including anxiety, depression, and body image disturbances. However systematic examination of bullying experiences and their psychological correlates in adolescents with gynecomastia remains limited. This study aims to investigate peer victimization prevalence and its relationship with psychological outcomes in this vulnerable population. This case-control study included 155 male adolescents aged 10-17 years, comprising 78 participants with gynecomastia and 77 healthy controls. Gynecomastia diagnosis and severity were assessed using clinical examination and Rohrich classification. Participants completed validated Turkish versions of the Olweus Bully/Victim Questionnaire, Rosenberg Self-Esteem Scale, and Revised Child Anxiety and Depression Scale. Adolescents with gynecomastia demonstrated significantly elevated peer victimization rates compared to controls (34.6% versus 16.9%, p=0.012), with markedly increased victim-perpetrator status (12.8% versus 1.3%, p=0.005). Gynecomastia diagnosis increased victimization risk 2.63-fold (95% CI: 1.076-6.436, p=0.034). Victimized participants exhibited elevated anxiety and depression scores across multiple symptom domains (p < 0.05). Behavioral modifications were prevalent, including altered clothing preferences (58.9%), changing room avoidance (44.8%), and swimming avoidance (41.0%). Adolescents with gynecomastia experience substantially elevated peer victimization with consequential psychological impact. These findings underscore the imperative for routine bullying assessment during clinical evaluation and implementation of comprehensive psychosocial screening protocols with early intervention strategies.

Introduction: Idiopathic gynecomastia is a common diagnosis among adolescents. Closed-suction drain placement after breast resection is traditionally performed to prevent complications such as seroma or hematoma, although its effectiveness remains controversial. Drains are also associated with patient discomfort and may require prolonged wound care. The aim of the present study is to describe our experience with the outpatient surgical treatment of adolescent gynecomastia without closed-suction drain placement and to assess its short- and long-term outcomes. Methods: We conducted a retrospective single-center cohort study including male patients under 18 years of age operated on for idiopathic gynecomastia between 2019 and 2023. Demographic data, clinical features (grade of gynecomastia according to Simon’s classification before surgery), intraoperative variables, and postoperative outcomes were collected. Patients were followed in the outpatient setting, with assessment of early (<30 days) and late complications. Results: A total of 21 consecutive patients were included, with a median age of 14.5 years (range 13.6–17.4). Sixteen patients (76.2%) underwent bilateral mastectomies, and five (23.8%) underwent unilateral subtotal mastectomies. Gynecomastia grade was I in 6 cases (28.6%), II in 12 (57.1%), and III in 3 (14.3%). No intraoperative adverse events occurred. Compressive chest bandaging was performed without closed-suction drainage. All patients were discharged on the same day. Two patients (9.5%) developed mild seroma during follow-up, both resolving spontaneously without aspiration or surgery. Conclusions: Our preliminary findings suggest that outpatient gynecomastia surgery without closed-suction drains appears to be a safe and effective option in adolescents, minimizing discomfort and avoiding hospital admission. However, larger, multicenter comparative studies are warranted to confirm these results and to further evaluate patient satisfaction and long-term cosmetic outcomes.

Gynecomastia is common during adolescence, yet its relationship with body composition remains unclear. This study investigates differences in body composition, fat distribution, and hormonal profiles between adolescents with gynecomastia and healthy controls. This case-control study included 70 adolescents diagnosed with gynecomastia and 67 healthy controls matched for age and Tanner stage. Anthropometric measurements, bioelectrical impedance analysis (BIA), and serum hormonal profiles were assessed. Body composition parameters, including fat mass (FM), fat-free mass (FFM), muscle mass (MM), bone mass (BM), total body water (TBW), muscle-to-fat mass ratio (MFR), and basal metabolic rate (BMR), were measured using the Tanita MC-780 MA device. Adolescents with gynecomastia exhibited significantly higher trunk fat mass (trunk fat mass: 20.60± 9.48 % vs. 17.64± 6.61 %, p=0.0462) and hormonal alterations, including reduced follicle-stimulating hormone (FSH) and free thyroxine (fT4) levels (FSH: 2.7± 1.4 vs. 3.5± 2.0 IU/L, p=0.0164; fT4 12.4± 1.9 vs. 13.1± 2.5 p=0.0193). These findings highlight the interplay between adiposity and endocrine changes in gynecomastia, warranting further exploration of underlying causative factors.

Gynecomastia can be the expression of physiological processes and be temporary in nature (pubertal gynecomastia) but can also occur at any other age. It is therefore acommon illness and, depending on the severity of the symptoms, can mean agreat deal of psychological stress for the patient. Enlargement of the male breast is usually abenign finding; causes can be endocrine disorders, previously undetected systemic diseases or drug side effects. Male breast cancer in particular is arare but important differential diagnosis. The diagnostic evaluation therefore aims at an endocrine clarification and the exclusion of neoplasms. Treatment can be conservative or surgical.

Background: This study aimed to explore the application value of magnetic resonance imaging (MRI)-based three-dimensional segmentation and reconstruction technology for spatial structural identification and volumetric quantification of glandular and adipose tissues in bilateral gynecomastia (GM) patients undergoing surgical treatment, hoping to provide precise imaging data to support clinical surgical decision-making. Methods: A retrospective analysis was performed on preoperative MRI images and general clinical data of 52 patients with bilateral gynecomastia at the patient level (bilateral totals, N = 52) who underwent surgical treatment in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, from March 2023 to September 2024. All images were acquired using a SIEMENS Aera 1.5 T MRI scanner with T1-weighted three-dimensional fat-suppressed sequence (t1_fl3d_tra_spair). Semi-automatic segmentation and active contour modeling (Snake model) using ITK-SNAP 4.0 software were employed to independently identify glandular and adipose tissues, reconstruct accurate three-dimensional anatomical models, and quantitatively analyze tissue volumes. Results: The MRI-based three-dimensional segmentation and reconstruction method accurately distinguished glandular and adipose tissues in male breasts, establishing precise three-dimensional anatomical models with excellent reproducibility and operational consistency. Among the 52 patients with bilateral gynecomastia, glandular tissue volume exhibited a markedly non-normal distribution, with a median of 6.11 cm3 (IQR, 3.03–12.98 cm3). Adipose tissue volume followed a normal distribution with a mean of 1348.84 ± 494.97 cm3. The total breast tissue volume also showed a normal distribution, with a mean of 1361.97 ± 496.83 cm3. The proportion of glandular tissue in total breast volume was non-normally distributed with a median of 0.50% (IQR, 0.27–1.21%), while the proportion of adipose tissue was also non-normally distributed with a median of 99.50% (IQR, 98.79–99.73%). Conclusions: MRI combined with computer-assisted three-dimensional segmentation and reconstruction technology efficiently and accurately achieves spatial identification, three-dimensional modeling, and volumetric quantification of glandular and adipose tissues in patients with bilateral gynecomastia. It objectively reveals the spatial compositional characteristics of male breast tissues. This approach provides precise, quantitative data for clinical decision-making regarding surgical treatment of gynecomastia, featuring robust standardization and strong clinical applicability.

Objectives: Gynecomastia and mastalgia are the most typical clinical breast conditions. This systematic review aims to assess the effect of selective estrogen receptor modulators (SERMs) on pubertal gynecomastia and mastalgia. Methods: In this review study, online English databases such as PubMed, Scopus, Web of Science, and Cochrane Library were systematically searched without a time limit until January 10, 2025. Results: Tamoxifen and centchroman are both more effective than placebo in relieving breast pain. Centchroman can reduce the severity of mastalgia by 92-100%. Pain score significantly reduced in the centchroman group compared to the placebo group (P &lt; 0.0001). Centchroman and tamoxifen similarly affected pain relief (P &lt; 0.005). Tamoxifen was more effective than danzol in relieving breast pain (P &lt; 0.001). The effects of tamoxifen were not dose dependent, as 10 mg and 20 mg did not follow a trend, but 10 mg produced significantly fewer side effects. There are inconsistent results when comparing the efficacy of danazol and centchroman at 12 weeks. However, tamoxifen outperformed danazol long-term AT 24 weeks. Four case series were included in the systematic review. Tamoxifen and raloxifene may be effective for the treatment of pubertal gynecomastia. In the first, reduction in breast nodule diameter was 86% in the tamoxifen group and 91%in the raloxifene group. However, a more significant improvement was observed in the tamoxifen group than in the raloxifene group (P = 0.03). In the second study, both groups had a statistically significant breast size reduction (tamoxifen group, P = 0.013; no treatment group, P = 0.038). In the third and fourth studies, the treatment success rate with tamoxifen was calculated to be 86 to 94%. Conclusions: Mild cyclic mastalgia can be treated by making appropriate lifestyle changes. Moderate to severe mastalgia usually requires medical treatment. Ormeloxifene, tamoxifen, and danazol were all effective in relieving breast pain. Tamoxifen and raloxifene may be effective for the treatment of pubertal gynecomastia.

Introduction: Physiological changes in the body may result in anxiety and impaired self-concept during adolescence.Although temporary, pubertal gynecomastia (PG) may cause negative emotions that interrupt the development of self-concept by causing a physical appearance that does not fit the male gender.This paper aimed to identify whether the self-concept level of adolescents with PG is moderated by their anthropometrics.Materials and Methods: This case-control study included adolescent males, with pubertal stage assessed using the Marshall and Tanner criteria.PG was diagnosed by palpation of a subareolar glandular disc.Anthropometric measurements were obtained by trained pediatric endocrinology clinic staff, and self-concept was evaluated using the Piers-Harris Children's Self-Concept Scale (PHCSCS).To specify relationships correlation and regression analysis were examined. Results:The study included 38 adolescents with PG and 61 age-and pubertal stagematched controls.BMI was significantly higher in the PG group, and self-concept scores declined with increasing BMI (p=0.044;r=-0.437,p=0.006).PG subjects at Tanner Stage 3 were shorter than controls (p=0.03)and had lower happiness and behavior subscale scores (p=0.01;p=0.04).PG duration was negatively correlated with total self-concept (r=-0.400,p=0.013) and the subscales of happiness (r=-0.456),behavior (r=-0.334),and physical appearance (r=-0.354). Conclusion:Adolescents with PG demonstrated lower self-concept, particularly in relation to higher BMI, shorter stature at mid-puberty, and prolonged symptom duration.These findings highlight the need for early psychosocial support in affected individuals. zGiri: Vcuttaki fizyolojik deiiklikler ergenlik dneminde kaygyla ve bozulmu z-kavramla sonulanabilir.Geici olmasna ramen, pubertal jinekomasti (PG), erkek cinsiyetine uymayan bir fiziksel grnme neden olarak z-kavram geliimini kesintiye uratan olumsuz duygulara neden olabilir.

Objective: Pubertal gynecomastia may have adverse psychosocial consequences, yet the influence of psychological resilience has been insufficiently explored. Methods: In this case-control study, 36 adolescents with clinically and ultrasonographically confirmed pubertal gynecomastia and 40 healthy controls (ages 11-18) were assessed. Body mass index (BMI) and gynecomastia severity (Rohrich classification) were recorded. Participants completed the Revised Child Anxiety and Depression Scale–Child Version (RCADS-CV), the Adolescent Psychological Resilience Scale (APRS), and the Body Appreciation Scale (BAS). Between-group comparisons and correlations were examined, and MANCOVA was conducted to control for potential confounders. Results: Adolescents in the pubertal gynecomastia group reported significantly lower levels of psychological resilience (F(1, 70)= 62.198, P &lt; .001, η²P= 0.471) and body appreciation (F(1, 70)= 5.21, P= .026, η²P = 0.069) compared to the control group, even after controlling for BMI. Although overall anxiety and depression scores did not differ significantly, social phobia approached the significance threshold (t(74) = 1.893, P = .062). Gynecomastia severity was linked to reduced body appreciation (F(2, 28) = 6.621, P = .004, η²P = 0.321). BMI independently predicted lower resilience (F(1, 70) = 4.77, P= .032, η²P= 0.064) and body appreciation (r= −0.308, P = .007) but did not directly contribute to anxiety or depression. Conclusion: While pubertal gynecomastia may not invariably manifest as clinical anxiety or depression, it appears to elevate social phobia risk and undermine both body image and resilience. Psychosocial interventions can mitigate these adverse effects, especially in adolescents who are not candidates for surgical intervention. Cite this article as: Meral Y, Sezgin M, Özer Y. Psychological resilience, body appreciation, and associations with anxietyand depression in pubertal gynecomastia: A case-controlled study. Neuropsychiatr Invest. 2025; 63, 0018, doi:10.5152/NeuropsychiatricInvest.2025.25018.

Gynecomastia (GM) is the most common abnormality of the male breast; it is benign and usually bilateral. GM is a manifestation of disease and not a diagnosis in itself. An important differential diagnosis of unilateral GM is breast cancer. This narrative review is based on pertinent publications from 2010 onward that were retrieved by a PubMed search, with special attention to the guidelines of the AWMF and the European Academy of Andrology (EAA) and the recommendations of the German Society for Gynecology and Obstetrics. GM can occur physiologically in newborns, during puberty, and in men over age 65. The basic diagnostic evaluation of GM consists of a thorough history and physical examination (especially of the breast area and genitals), breast and testicular sonography, and laboratory testing for total testosterone (tT), estradiol (E2), luteinizing hormone (LH), human chorionic gonadotropin (hCG), and prolactin (PRL) levels. Further tests to be carried out as indicated according to the clinical findings include the determination of follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), fT4, alpha-1-fetoprotein (AFP), dehydroepiandrosterone (DHEA), and free testosterone (fT) levels, liver and kidney function tests, chromosomal analysis, and supplementary imaging procedures. The treatment depends on the underlying disease and the severity of symptoms, ranging from further observation alone to pharmacotherapy and surgery. Approximately 700 men receive a diagnosis of breast cancer each year in Germany. Because breast cancer in men is rare, there are no pertinent studies, and its treatment is analogous to the treatment of breast cancer in women as recommended in the guidelines. Men should be included in clinical trials of treatment for breast cancer whenever this is fea - sible, so that the evidence base can be enlarged and men can be given access to innovative treatment methods.

Gynecomastia (GM) is a common benign proliferation of male breast tissue that can significantly impact patients' physical and mental health. Endoscopic subcutaneous mastectomy (ESCM) has emerged as a promising minimally invasive approach for treating GM. However, the relative efficacy of different techniques for creating operative space during ESCM remains unclear. This study aims to compare the clinical outcomes of non-liposuction and liposuction techniques in single-port ESCM for GM treatment. This retrospective study included 41 GM patients who underwent single-port ESCM via bilateral axillary approach at Shandong Maternal and Child Health Hospital between September 2022 and September 2023. Patients were divided into non-liposuction (n=20) and liposuction (n=21) groups. Operative time, blood loss, postoperative drainage volume, complication rates, and patient satisfaction were compared between the two groups. All procedures were successfully completed without conversion to open surgery. The non-liposuction group had significantly shorter mean operative time compared to the liposuction group (124.30 vs 168.81 minutes, P<0.001). Postoperative day 1 drainage volume was also significantly lower in the non-liposuction group (43.40 vs 107.05 mL, P<0.001). No significant differences were observed in intraoperative blood loss, complication rates, or patient satisfaction between the two groups. The overall complication rate was 7.3% (3/41), with two cases in the liposuction group and one in the non-liposuction group. No recurrences were reported during the 12-month follow-up period. Single-port ESCM is a safe and effective method for treating GM. Compared to the liposuction technique, the non-liposuction approach demonstrates significant advantages in reducing operative time and postoperative drainage volume while maintaining comparable safety and patient satisfaction. These findings provide new insights for optimizing GM treatment strategies and potentially improving patient outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUNDMetabolic dysfunction-associated fatty liver disease (MASLD) is a chronic liver disease characterized by hepatocellular steatosis, which is closely related to metabolic syndrome, with annually increasing morbidity in recent years. Gynecomastia (GYN), an abnormal proliferation of breast tissue in males, is common in males with sex hormone imbalance. Currently, there is insufficient research on the morbidity of GYN and its correlation among MASLD patients.AIMTo investigate the prevalence of GYN and its associated clinical features in patients with MASLD and determine the prevalence of GYN in patients with MASLD and analyze the predictive effect of sex hormones on GYN using receiver operating characteristic (ROC) curves.METHODSA cross-sectional study was conducted in a tertiary care hospital. Among them, 997 patients met the inclusion criteria and underwent breast ultrasonography to determine the presence of GYN. Anthropometric data, laboratory test data [estradiol (E2), androgens, liver function, glucose, lipids, low-density lipoprotein, high-density lipoprotein, creatinine, and uric acid, etc.], as well as information on medical history, severity of fatty liver (mild, moderate, and severe), and duration of the disease were collected. Package for the Social Sciences version 27 and R software (version 4.3.1) were used for data analysis.RESULTSThe prevalence of GYN increased with the severity of fatty liver (27.6% for mild, 33.5% for moderate, and 58% for severe, P < 0.001); compared with non-GYN patients, GYN patients were older (54.11 ± 9.71 years vs 47.89 ± 9.92 years, P < 0.001), with significantly higher E2 levels, higher estrogen to androgen ratio (P < 0.001) and significantly lower androgen levels (P < 0.001). In ROC curve analysis, the combined model of testosterone and E2 had a high diagnostic value in predicting GYN in MASLD patients, surpassing a single indicator.CONCLUSIONThe presence of GYN may suggest more severe metabolic abnormalities in patients with MASLD. Therefore, early recognition of GYN may be crucial for early intervention in metabolic syndrome and endocrine abnormalities in patients with MASLD.

This study aimed to explore depression, anxiety, and body image issues in adolescents with gynecomastia. Forty adolescents aged 12-18years diagnosed with gynecomastia and 40 age-matched volunteer healthy adolescent boys were enrolled. Mental health issues were assessed using Beck Anxiety Inventory (BAI), Social Appearance Anxiety Scale (SAAS), the Children's Depression Inventory (CDI), Body Cathexis Scale (BCS), and the Brief Fear of Negative Evaluation Scale (BFNE). The mean (SD) BFNE [29.82 (10.08) vs. 24.62 (9.96); P = 0.023] and the SAAS [42.27 (18.15) vs. 31.32 (14.71); P = 0.004] scales were significantly higher in the patient group compared to controls. A significant negative correlation was observed between age and SAAS (r = - 0.349), and age and BFNE (r = - 0.522). A significant positive correlation was seen between SAAS and the grade of gynecomastia (r = 0.479). Early psychological support is needed to reduce distress in adolescents with gynecomastia.

Leptin levels may not have a role in the development of pubertal gynecomastia

To evaluate the clinical efficacy of gasless and single-port gas-insufflation transaxillary approaches in subcutaneous mastectomy for treating patients with gynecomastia (GM). This study enrolled 46 patients with GM from May 2022 to October 2023. Twenty patients underwent subcutaneous mastectomy using the single-port gas-insufflation transaxillary approach (gas-insufflation group), while the other 26 patients received the same procedure through the gasless transaxillary approach (gasless group). This study further conducted inter-group comparisons in terms of the operation time, intraoperative bleeding, volume of postoperative drainage, timing of drainage tube removal, short-term postoperative complications, length of postoperative hospital stay, and medical costs. All the 46 patients completed the operation successfully without conversion to open surgery, with confirmed diagnosis of GM through pathology. The average surgical time for the gasless group was significantly shorter than that of the gas-insufflation group (38.20 ± 10.773 vs. 62.96 ± 15.311 min, P < 0.01). There were no significant differences between groups in incision length, intraoperative bleeding, unilateral postoperative drainage volume, drainage tube retention time, length of postoperative hospital stay, or postoperative cosmetic outcomes (all P > 0.05). This study supports the clinical feasibility of using gasless transaxillary approach for subcutaneous mastectomy of patients with GM.

Background: Pubertal gynecomastia is the most common breast swelling seen in adolescent males. It may affect up to 70% of male adolescents, with a peak age of appearance around 14 years. However, it may cause significant psychological disturbance, depression, and also mastalgia. Hence, we decided to analyze our data of tamoxifen treatment in pubertal gynecomastia. Methods: We did a retrospective study of all adolescent boys who presented to us with a history of unilateral or bilateral breast enlargement. We collected the data of all patients who were treated with tamoxifen 10 mg twice daily. Results: We included 45 patients in this study. The mean age of presentations was 14.2 years (standard deviation –3.8 years). Of these, 28 patients (62.2%) had bilateral gynecomastia and 17 patients (37.8%) had unilateral gynecomastia. The majority of them complained of mastalgia, i.e., 41 patients (91.1%). Of these 45 patients, 36 (80%) patients had complete response with disappearance of breast swelling with tamoxifen treatment. Five patients had considerable reduction in the size of swelling. Only four patients did not respond to the treatment, although they had mild reduction in size. Subsequently, these four patients underwent surgical resection since they had significant breast enlargement even after therapy. All patients with mastalgia responded to tamoxifen therapy with disappearance of pain within 3 months of treatment. Conclusion: Tamoxifen is safe for the treatment of pubertal gynecomastia. It is useful in not only in decreasing the pain but also causes complete disappearance of swelling in the significant number of patients if treatment is started early.