Infra-areolar subcutaneous mastectomy in the surgical treatment of adolescent gynecomastia
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In brief
In brief
This retrospective study of 21 adolescent boys demonstrates that infra-areolar subcutaneous mastectomy via semilunar incision provides excellent cosmetic outcomes for pubertal gynecomastia with minimal complications. The technique capitalizes on good skin elasticity in adolescents, yielding nearly invisible scarring and natural chest contour, addressing both physical and psychological concerns in this patient population.
- Only 5-10% of pubertal gynecomastia cases require surgical intervention; most resolve spontaneously.
- Infra-areolar subcutaneous mastectomy via semilunar incision provides excellent cosmetic outcomes with minimal visible scarring.
- Technique works best in normal-weight adolescents with good skin elasticity; 76% of patients were normal BMI in this series.
- Seroma is the most common early complication (9.5% in this series); long-term outcomes are excellent without recurrence.
- Pre-operative workup should include hormonal evaluation to exclude hypogonadism and chromosomal anomalies as underlying causes.
Written by the GCMD Library team from the article.
Abstract
Background
Despite being a common condition in puberty, only 5–10% of pubertal gynecomastia need surgical treatment. Here the authors present their experiences with infra-areolar subcutaneous mastectomy in the surgical treatment of adolescent gynecomastia.
Methods
The records of patients who underwent infra-areolar subcutaneous mastectomy for adolescent gynecomastia between January 2004 and December 2021 were reviewed retrospectively. The patients' demographic data, complaints and clinical presentation, physical examination, laboratory and radiological findings, surgical management, and postoperative follow-ups were evaluated. The patients were evaluated according to the localization of the gynecomastia (unilateral/bilateral) and according to the patients’ body mass index (BMI) (normal/overweight).
Results
A total of 21 boys with a mean age of 15 ± 1.4 years were operated by the senior author and infra-areolar subcutaneous mastectomy by a semilunar incision was performed for adolescent gynecomastia. The mean duration of the complaint was 24.2 ± 10.9 months. Gynecomastia was bilateral in 15 (71.5%) and unilateral in 6 (28.5%) of the patients. Sixteen patients (76.2%) were normal weight, 5 (23.8%) were overweight. Chromosomal anomaly and hypogonadism were detected in two patients. Pseudoangiomatous stromal hyperplasia was detected in the pathology of one patient. The mean follow-up time was 2.7 ± 1 years, seroma developed in 2 patients at the early postoperative period. Their long-term follow-up was uneventful without complication.
Conclusions
The results of infra-areolar subcutaneous mastectomy are very promising in pubertal gynecomastia due to good skin elasticity and without obesity in the adolescent age group. We believe that this method provides an almost invisible incision and a natural pectoral appearance for adolescent patients who have experienced serious emotional problems related to their body images.