Management of Gynecomastia in Patients With Different Body Types: Considerations on 312 Consecutive Treated Cases

Abstract

Background: Gynecomastia is a common finding in male subjects which incidence varies widely in the world population. In adolescents, it is frequently temporary but, if it becomes persistent, it generates considerable embarrassment, inducing the patients to seek surgical consultation. Even in patients with good body contour, gynecomastia creates even greater distress considering the special attention given by these subjects to their physical appearance. The authors present their experience in the treatment of gynecomastia comparing different body types of patients with the aim to investigate dissimilar expectations, needs and surgical outcomes thus optimizing the management of the pathological condition, achieving high levels of agreement and reducing unsatisfied patients arising from cosmetic surgery.

Materials and methods: Between January 2007 and January 2015, 312 selected patients have been treated surgically for gynecomastia. Patients were grouped according to their physical aspect: 97 were classified as high muscle mass body type (group A), 106 as normal (group B) and 109 as overweight patients (group C). All of them were adults ranging in age between 18 and 52 years. Follow-up ranged from 12 to 60 months. In all cases, an excision of the gland in the form of a subcutaneous mastectomy was performed; the most common surgical access was in the inferior part of the areola.

Results: No breast cancers were found at the histological examinations. Also, no skin or areola necrosis have been referred, and no recurrence of gynecomastia disorder has been reported. Six cases of seroma (limited to the fatty gynecomastia) and 3 cases of hematomas (requiring immediate surgical revision) were found. Although the patients in group B resulted more distressed by the disorder, higher levels of postoperative satisfaction were recorded in this group.

Conclusions: The study demonstrates the importance of the different management of the same disorder according to the different patients' expectations, related to the different body type. Our experience demonstrated that most of the cases did not require extensive skin incisions, reducing the risk of unpleasant scars and that direct excision of glandular tissue ensures stable and satisfactory results.

FIGURE 1

Subdivision of 312 patients surgically treated for gynecomastia in 3 groups according to their body types.

FIGURE 2

A 22-year-old man with high definition muscle body type: (A) preoperative lateral view showing wide areola, (B) postoperative lateral view showing a better definition of pectoralis area with a significant decreasing of areola diameter.

FIGURE 3

An 18-year-old man with normal body type: (A) preoperative lateral view showing an evident female appearance of the pectoralis region; (B) postoperative lateral view showing a significant disappearance of female aspect.

FIGURE 4

A 45-year-old man with overweight body type presented a severe gynecomastia since his early teenage years. His gynecomastia became more pronounced at age of 16. Good quality of skin texture was observed. A, Preoperative frontal view showing significant female ptotic breasts with wide areola. B, Postoperative frontal view showing a satisfactory resolution of the gynecomastia disorder obtained through a full-circle areola approach with a significant decreasing of areola diameter.

FIGURE 5

A 21-year-old man presented a severe gynecomastia related to Klinefelter Syndrome. A, preoperative frontal view; (B) postoperative frontal (C) and lateral view showing a satisfactory result.

FIGURE 6

Causes of emotional distress in patients affected by gynecomastia, with identification of different causes among the 3 body types groups.

FIGURE 7

Analysis of preoperatory and postoperatory satisfaction with chest appearance using the likert score.