madman
Super Moderator
Introduction: Gynecomastia (GM) is a benign proliferation of glandular breast tissue in men. Some cases need surgical intervention. Traditional open surgery by the semicircular inferior periareolar incision is the most common surgical approach. In order to obtain better esthetic results, some alternatives to open surgery have been proposed, such as liposuction, endoscopic mastectomy, and vacuum-assisted excision (VAE).
Objective: To describe the technical surgical approach of ultrasound-guided VAE of GM and its results from a case series.
Method: This is an evaluation of seven GM cases submitted to ultrasound-guided VAE with a 10G needle using the ENCOR® BD whole circumference automated breast biopsy system in Redimasto – Redimama, a Brazilian breast center. The result was considered good or satisfactory when it showed minimal remaining gland, good symmetry, no retraction, necrosis, hypertrophic scar, or displacement of the nipple-areola complex. All patients answered a questionnaire to evaluate their satisfaction and perception of the procedure.
Results: Seven (7) patients with Simon grade 1 and 2 bilateral GM underwent ultrasound-guided VAE. No case of displacement, necrosis, or retraction of the nipple-areola complex, post-procedure bleeding, infection, skin necrosis, or asymmetry was detected. No patient reported a decrease or change in nipple sensation or erection. All patients had bruises and hematomas that spontaneously resolved within 30 days. All results were considered good or excellent by patients and surgeons.
Conclusion: Minimally invasive ultrasound-guided VAE is an excellent alternative for the treatment of GM. It is better indicated for Simon grade 1 and 2 GM, with good and excellent esthetic results, small scar, and low rates of nipple and areolar complications. It allows an outpatient procedure with low morbidity (local anesthesia) and fast recovery.
INTRODUCTION
Gynecomastia (GM) is a benign proliferation of glandular breast tissue in men 1. It is the most common male breast disorder, accounting for nearly 60% of them. It can be unilateral or, most often, bilateral. GM is a common condition with a prevalence of 32% to 65%, depending on age, and can affect up to 70% of all pubescent boys 2. A man’s lifespan has three peaks: the first occurs during infancy, the second during puberty, and the third in middle-aged and older men 1,2. GM in infancy and puberty resolves spontaneously in most cases. Proper investigation is highly recommended among adults and older adults to exclude underlying diseases1.
GM typically results from an absolute or relative deficiency of androgen action or excessive estrogen action in the breast tissue 2. No treatment is necessary for asymptomatic adolescents or men, but it is required when GM is progressive, painful, or causes cosmetic discomfort. It usually resolves by itself or by removing the underlying cause, such as medication, anabolic-androgenic steroid abuse, or treatment of systemic diseases 3. Medical therapy can also be prescribed for patients with a recent diagnosis — within two years —, but is less effective for long-standing GM. Some cases need surgical intervention. According to Simon, GM can be classified into grades 4 (Table 1).
Traditional open surgery by semicircular inferior periareolar incision is the most common surgical approach, but it may cause significant morbidities, such as asymmetry, poor scarring, and nipple-areola complex retraction or necrosis 5-7. In order to obtain better esthetic results, some alternatives to open surgery have been proposed, such as liposuction, endoscopic mastectomy, and vacuum-assisted excision (VAE) 7-9
*In the last few years, the use of vacuum-assisted devices, originally created to diagnose breast lesions by radiologically guided procedures, has shown to be promising in the surgical management of GM 8-12.
CONCLUSION
Minimally invasive ultrasound-guided VAE is an excellent alternative for the treatment of GM. It is better indicated for Simon grade 1 and 2 GM, with good and excellent esthetic results and low rates of nipple and areolar complications. It allows an outpatient procedure with low morbidity (local anesthesia) and fast recovery. Hematomas and bruises are always present due to the nature of the approach. Breast surgeons can obtain satisfactory cosmetic results with little morbidity and postoperative complications, such as nipple retraction or necrosis. Ultrasound-guided VAE has become a valuable approach for the surgical management of Simon grade 1 and 2 GM, with or without liposuction according to necessity. Trials comparing VAE of GM with open surgery should also evaluate clinically relevant recurrence throughout the years to establish the safety of these surgical approaches over time.
Objective: To describe the technical surgical approach of ultrasound-guided VAE of GM and its results from a case series.
Method: This is an evaluation of seven GM cases submitted to ultrasound-guided VAE with a 10G needle using the ENCOR® BD whole circumference automated breast biopsy system in Redimasto – Redimama, a Brazilian breast center. The result was considered good or satisfactory when it showed minimal remaining gland, good symmetry, no retraction, necrosis, hypertrophic scar, or displacement of the nipple-areola complex. All patients answered a questionnaire to evaluate their satisfaction and perception of the procedure.
Results: Seven (7) patients with Simon grade 1 and 2 bilateral GM underwent ultrasound-guided VAE. No case of displacement, necrosis, or retraction of the nipple-areola complex, post-procedure bleeding, infection, skin necrosis, or asymmetry was detected. No patient reported a decrease or change in nipple sensation or erection. All patients had bruises and hematomas that spontaneously resolved within 30 days. All results were considered good or excellent by patients and surgeons.
Conclusion: Minimally invasive ultrasound-guided VAE is an excellent alternative for the treatment of GM. It is better indicated for Simon grade 1 and 2 GM, with good and excellent esthetic results, small scar, and low rates of nipple and areolar complications. It allows an outpatient procedure with low morbidity (local anesthesia) and fast recovery.
INTRODUCTION
Gynecomastia (GM) is a benign proliferation of glandular breast tissue in men 1. It is the most common male breast disorder, accounting for nearly 60% of them. It can be unilateral or, most often, bilateral. GM is a common condition with a prevalence of 32% to 65%, depending on age, and can affect up to 70% of all pubescent boys 2. A man’s lifespan has three peaks: the first occurs during infancy, the second during puberty, and the third in middle-aged and older men 1,2. GM in infancy and puberty resolves spontaneously in most cases. Proper investigation is highly recommended among adults and older adults to exclude underlying diseases1.
GM typically results from an absolute or relative deficiency of androgen action or excessive estrogen action in the breast tissue 2. No treatment is necessary for asymptomatic adolescents or men, but it is required when GM is progressive, painful, or causes cosmetic discomfort. It usually resolves by itself or by removing the underlying cause, such as medication, anabolic-androgenic steroid abuse, or treatment of systemic diseases 3. Medical therapy can also be prescribed for patients with a recent diagnosis — within two years —, but is less effective for long-standing GM. Some cases need surgical intervention. According to Simon, GM can be classified into grades 4 (Table 1).
Traditional open surgery by semicircular inferior periareolar incision is the most common surgical approach, but it may cause significant morbidities, such as asymmetry, poor scarring, and nipple-areola complex retraction or necrosis 5-7. In order to obtain better esthetic results, some alternatives to open surgery have been proposed, such as liposuction, endoscopic mastectomy, and vacuum-assisted excision (VAE) 7-9
*In the last few years, the use of vacuum-assisted devices, originally created to diagnose breast lesions by radiologically guided procedures, has shown to be promising in the surgical management of GM 8-12.
CONCLUSION
Minimally invasive ultrasound-guided VAE is an excellent alternative for the treatment of GM. It is better indicated for Simon grade 1 and 2 GM, with good and excellent esthetic results and low rates of nipple and areolar complications. It allows an outpatient procedure with low morbidity (local anesthesia) and fast recovery. Hematomas and bruises are always present due to the nature of the approach. Breast surgeons can obtain satisfactory cosmetic results with little morbidity and postoperative complications, such as nipple retraction or necrosis. Ultrasound-guided VAE has become a valuable approach for the surgical management of Simon grade 1 and 2 GM, with or without liposuction according to necessity. Trials comparing VAE of GM with open surgery should also evaluate clinically relevant recurrence throughout the years to establish the safety of these surgical approaches over time.
