Aesthetic Plastic Surgery

, Volume 37, Issue 5, pp 1012–1022

Management of Prepubertal Gynecomastia in Two Monozygotic Twins With Peutz-Jeghers Syndrome: From Aromatase Inhibitors To Subcutaneous Mastectomy

  • Giuseppe Andrea Ferraro
  • Tiziana Romano
  • Francesco De Francesco
  • Anna Grandone
  • Francesco D’Andrea
  • Emanuele Miraglia del Giudice
  • Chiara Cataldo
  • Gianluca Gatta
  • Graziella Di Grezia
  • Laura Perrone
  • Gianfranco Nicoletti
Original Article Experimental/Special Topics

DOI: 10.1007/s00266-013-0188-z

Cite this article as:
Ferraro, G.A., Romano, T., De Francesco, F. et al. Aesth Plast Surg (2013) 37: 1012. doi:10.1007/s00266-013-0188-z

Abstract

Background

Prepubertal gynecomastia is characterized by the presence of palpable uni- or bilateral breast tissue in boys without other signs of sexual maturation. It may be the endocrine expression of rare syndromes such as Peutz-Jeghers syndrome (PJS). This study aimed to evaluate the effectiveness of anastrozole and to describe an innovative surgical approach.

Methods

This report presents twins with PJS, bilateral prepubertal gynecomastia, and testicular multifocal calcifications. Both twins were treated with anastrozole for 2 years. After finishing treatment, both were followed before subcutaneous mastectomy was performed by the “modified” Webster technique.

Results

Growth velocity decreased and gynecomastia diminished during anastrozole treatment. After discontinuation of therapy due to a sharp reduction in growth velocity, both twins showed regrowth of gynecomastia, with painful and strained breasts. A significant reduction in breast volume with glandular removal was achieved.

Conclusions

The findings of this study showed a multidisciplinary approach to prepubertal gynecomastia due to the synergy of pediatricians, radiologists, and plastic surgeons. The follow-up evaluation after the anastrozole treatment showed it to be an efficacious medical treatment, as an alternative to orchidectomy, to control the effects of circulating estrogens. Moreover, the results observed in the patients confirmed the validity and feasibility of the “modified” Webster technique in terms of aesthetic and functional results, patient satisfaction, and absence of complications.

Level of Evidence V

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.

Keywords

AnastrozoleGynecomastiaPeutz-JeghersSubcutaneous mastectomyTesticular cancerUltrasound

Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013

Authors and Affiliations

  • Giuseppe Andrea Ferraro
    • 1
  • Tiziana Romano
    • 2
  • Francesco De Francesco
    • 1
  • Anna Grandone
    • 2
  • Francesco D’Andrea
    • 1
  • Emanuele Miraglia del Giudice
    • 2
  • Chiara Cataldo
    • 1
  • Gianluca Gatta
    • 3
  • Graziella Di Grezia
    • 3
  • Laura Perrone
    • 2
  • Gianfranco Nicoletti
    • 1
  1. 1.Department of Orthopedic, Traumatologic, Rehabilitative, and Plastic-Reconstructive SciencesSecond University of NaplesNaplesItaly
  2. 2.Department of Pediatrics “F. Fede”Second University of NaplesNaplesItaly
  3. 3.Department of Clinical and Experimental Medicine “F. Magrassi, A. Lanzara”, Section of Radiology and RadiotherapySecond University of NaplesNaplesItaly