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Complications and Outcomes After Gynecomastia Surgery: Analysis of 204 Pediatric and 1583 Adult Cases from a National Multi-center Database

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Abstract

Background

Gynecomastia is a common disease that is prevalent across all age groups of boys and men. Although benign in nature, it can lead to psychological and social distress, prompting affected patients to seek medical attention. Management strategies include observation and drug therapy, yet surgical procedures remain the hallmark of treatment. The goal of this study was to analyze patient demographics, outcomes, and complication rates of gynecomastia surgery in a large multi-institutional cohort.

Methods

We performed a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases to produce two cohorts that underwent gynecomastia surgical repair. The two populations were compared for comorbidities, perioperative details, and complication rates. Multivariate analyses helped detect risk factors associated with adverse events.

Results

A total of 204 pediatric and 1583 adult male patients were identified in our analysis. Mean ages were 15.8 and 39.6 years, respectively. A BMI of 28.2 in the latter cohort revealed an overweight adult population. Preoperative comorbidities (0.0–4.9% in children, 0.0–6.4% in adults) and American Society of Anesthesiologists scores (ASA 1 + 2: 98.5 and 82.7%) symbolized a healthy population. Procedures were subsequently performed mostly as outpatient (84.3 and 93.9%) and with short hospitalization durations (0.27 and 0.06 days). Our results demonstrated low surgical (3.9 and 1.9%) and medical (0.0 and 0.3%) complications within the standardized 30-day postoperative period. Children and adolescents, however, required double mean operative times compared to adults (111.3 vs 56.7 min).

Conclusion

Operative gynecomastia treatment remains a safe treatment modality across all age groups. Patients with known preoperative medical or surgical comorbidities necessitate more extensive perioperative assessment and monitoring.

Level of Evidence III

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.

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References

  1. Kinsella C Jr, Landfair A, Rottgers SA et al (2012) The psychological burden of idiopathic adolescent gynecomastia. Plast Reconstr Surg 129(1):1–7

    Article  CAS  PubMed  Google Scholar 

  2. Lemaine V, Cayci C, Simmons PS, Petty P (2013) Gynecomastia in adolescent males. Semin Plastic Surg 27(1):56–61

    Article  Google Scholar 

  3. Braunstein GD (1993) Gynecomastia. N Engl J Med 328(7):490–495

    Article  CAS  PubMed  Google Scholar 

  4. Niewoehner CB, Nuttal FQ (1984) Gynecomastia in a hospitalized male population. Am J Med 77(4):633–638

    Article  CAS  PubMed  Google Scholar 

  5. Rohrich RJ, Ha RY, Kenkel JM, Adams WP Jr (2003) Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg 111(2):909–923 (discussion 924–905)

    Article  PubMed  Google Scholar 

  6. Cuhaci N, Polat SB, Evranos B, Ersoy R, Cakir B (2014) Gynecomastia: clinical evaluation and management. Indian J Endocrinol Metab 18(2):150–158

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wit JM, Hero M, Nunez SB (2012) Aromatase inhibitors in pediatrics. Nat Rev Endocrinol 8(3):135–147

    Article  CAS  Google Scholar 

  8. Prezioso D, Piccirillo G, Galasso R, Altieri V, Mirone V, Lotti T (2004) Gynecomastia due to hormone therapy for advanced prostate cancer: a report of ten surgically treated cases and a review of treatment options. Tumori 90(4):410–415

    PubMed  Google Scholar 

  9. Boljanovic S, Axelsson CK, Elberg JJ (2003) Surgical treatment of gynecomastia: liposuction combined with subcutaneous mastectomy. Scand J Surg 92(2):160–162

    Article  CAS  PubMed  Google Scholar 

  10. American Society of Plastic Surgeons (2015) Plastic surgery statistics report. https://d2wirczt3b6wjm.cloudfront.net/News/Statistics/2015/plastic-surgery-statistics-full-report-2015.pdf. Accessed 10 March 2016

  11. Davanco RA, Sabino Neto M, Garcia EB, Matsuoka PK, Huijsmans JP, Ferreira LM (2009) Quality of life in the surgical treatment of gynecomastia. Aesthet Plast Surg 33(4):514–517

    Article  Google Scholar 

  12. Fischer S, Hirsch T, Hirche C et al (2014) Surgical treatment of primary gynecomastia in children and adolescents. Pediatr Surg Int 30(6):641–647

    Article  PubMed  Google Scholar 

  13. Heckmann A, Leclere FM, Vogt PM, Steiert A (2011) Surgical therapy of gynecomastia. Chirurg 82(9):789–794, 796

    Article  CAS  PubMed  Google Scholar 

  14. Laituri CA, Garey CL, Ostlie DJ, St Peter SD, Gittes GK, Snyder CL (2010) Treatment of adolescent gynecomastia. J Pediatr Surg 45(3):650–654

    Article  PubMed  Google Scholar 

  15. Lanitis S, Starren E, Read J et al (2008) Surgical management of Gynaecomastia: outcomes from our experience. Breast 17(6):596–603

    Article  PubMed  Google Scholar 

  16. Li CC, Fu JP, Chang SC, Chen TM, Chen SG (2012) Surgical treatment of gynecomastia: complications and outcomes. Ann Plast Surg 69(5):510–515

    Article  CAS  PubMed  Google Scholar 

  17. Persichetti P, Berloco M, Casadei RM, Marangi GF, Di Lella F, Nobili AM (2001) Gynecomastia and the complete circumareolar approach in the surgical management of skin redundancy. Plast Reconstr Surg 107(4):948–954

    Article  CAS  PubMed  Google Scholar 

  18. American College of Surgeons (2014) ACS NSQIP participant use data file. https://www.facs.org/~/media/files/quality%20programs/nsqip/nsqip_puf_userguide_2014.ashx. Accessed 4 Oct 2016

  19. American College of Surgeons (2014) ACS NSQIP pediatric participant use data file. https://www.facs.org/quality-programs/pediatric/program-specifics/quality-support-tools/puf. Accessed 4 Oct 2016

  20. American Medical Association (2016) Current procedural terminology. http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page?. Accessed 4 Oct 2016

  21. Ersoz H, Onde ME, Terekeci H, Kurtoglu S, Tor H (2002) Causes of gynaecomastia in young adult males and factors associated with idiopathic gynaecomastia. Int J Androl 25(5):312–316

    Article  Google Scholar 

  22. Johnson RE, Murad MH (2009) Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc 84(11):1010–1015

    Article  PubMed  PubMed Central  Google Scholar 

  23. Flegal KM, Kit BK, Graubard BI (2014) Body mass index categories in observational studies of weight and risk of death. Am J Epidemiol 180(3):288–296

    Article  PubMed  PubMed Central  Google Scholar 

  24. UnitedHealthcare® (2016) UnitedHealthcare® commercial coverage determination guideline: gynecomastia treatment. http://bit.ly/1RQXpV5. Accessed 31 Oct 2016

  25. Niewoehner CB, Schorer AE (2008) Gynaecomastia and breast cancer in men. BMJ Br Med J 336(7646):709–713

    Article  Google Scholar 

  26. Ridha H, Colville RJ, Vesely MJ (2009) How happy are patients with their gynaecomastia reduction surgery? J Plast Reconstr Aesthet Surg 62(11):1473–1478

    Article  CAS  PubMed  Google Scholar 

  27. Tashkandi M, Al-Qattan MM, Hassanain JM, Hawary MB, Sultan M (2004) The surgical management of high-grade gynecomastia. Ann Plast Surg 53(1):17–20 (discussion 21)

    Article  PubMed  Google Scholar 

  28. Centers for Disease Control and Prevention (2014) National diabetes statistics report

  29. Brafa A, Campana M, Grimaldi L et al (2011) Management of gynecomastia: an outcome analysis in a multicentric study. Minerva Chir 66(5):375–384

    CAS  PubMed  Google Scholar 

  30. Gioffre Florio MA, Alfio AR, Fama F, Giacobbe G, Pollicino A, Scarfo P (2004) Evaluation of complications and long-term results after surgery for gynaecomastia. Chir Ital 56(1):113–116

    PubMed  Google Scholar 

  31. Handschin AE, Bietry D, Husler R, Banic A, Constantinescu M (2008) Surgical management of gynecomastia–a 10-year analysis. World J Surg 32(1):38–44

    Article  CAS  PubMed  Google Scholar 

  32. Kasielska A, Antoszewski B (2013) Surgical management of gynecomastia: an outcome analysis. Ann Plast Surg 71(5):471–475

    Article  CAS  PubMed  Google Scholar 

  33. Steele SR, Martin MJ, Place RJ (2002) Gynecomastia: complications of the subcutaneous mastectomy. Am Surg 68(2):210–213

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA

    Dmitry Zavlin, Jeffrey D. Friedman & Anthony Echo

  2. San Diego School of Medicine, University of California, La Jolla, CA, USA

    Kevin T. Jubbal

Authors
  1. Dmitry Zavlin
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  2. Kevin T. Jubbal
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Correspondence to Dmitry Zavlin.

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Conflict of interest

American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP and the ACS NSQIP Pediatric are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Ethical Approval

The work described in this manuscript was approved by our institutional review board (Protocol number Pro00011704: “Observational Research in the Department of Plastic and Reconstructive Surgery”). The authors adhered to the Declaration of Helsinki at all times.

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Zavlin, D., Jubbal, K.T., Friedman, J.D. et al. Complications and Outcomes After Gynecomastia Surgery: Analysis of 204 Pediatric and 1583 Adult Cases from a National Multi-center Database. Aesth Plast Surg 41, 761–767 (2017). https://doi.org/10.1007/s00266-017-0833-z

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  • DOI: https://doi.org/10.1007/s00266-017-0833-z

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