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Der Urologe

, Volume 47, Issue 4, pp 467–471 | Cite as

Die plastische chirurgische Therapie der Gynäkomastie nach antihormoneller Therapie bei Prostatakarzinom

  • H. Ryssel
  • G. Germann
  • E. Köllensperger
  • K. Riedel
Übersichten

Zusammenfassung

Die Gynäkomastie ist eine mögliche Behandlungsnebenwirkung bei der Hormontherapie im Rahmen der Behandlung des Prostatakarzinoms. Im Rahmen großer randomisierter kontrollierter Studien wurde bei ca. 50% der Männer mit Prostatakarzinom eine Gynäkomastie auf Grundlage verschiedener Mechanismen gefunden. Obwohl die Ausprägung der Gynäkomastie meist als mild bis moderat beschrieben wird, zählt sie jedoch zu den häufigsten Abbruchgründen einer solchen Therapie. Die Möglichkeit der Radiotherapie und der medikamentösen Therapie durch Tamoxifen führte zu einer Reduktion der Gynäkomastierate, es verbleiben jedoch immer noch viele therapieresistente Patienten, die eine plastisch-chirurgische Korrektur dieser Nebenwirkung benötigen.

Die Gynäkomastie ist eine benigne Vergrößerung der männlichen Brustdrüse und benötigt per se keine Behandlung, es sei denn, es besteht eine stigmatisierende und dadurch für den Patienten belastende Vergrößerung. Die Indikation für die chirurgische Behandlung der Gynäkomastie basiert auf zwei wesentlichen Punkten: der Rekonstruktion der männlichen Brust- und Thoraxform und der diagnostischen Evaluation suspekter Brustläsionen. Bei der chirurgischen Technik halten wir die komplette zirkumareoläre Technik ohne weitere Narben für die ästhetisch am besten geeignete Prozedur. In Kombination mit einer Fettabsaugung kann ein harmonisches und ästhetisch ansprechendes Ergebnis erzielt werden.

Schlüsselwörter

Prostatakarzinom Hormontherapie Gynäkomastie Plastisch-chirurgische Korrektur Zirkumareoläre Technik Fettabsaugung 

Plastic surgery for the treatment of gynaecomastia following hormone therapy in prostate carcinoma

Abstract

Gynecomastia is a potential side effect of hormone therapy for prostate cancer. In large, randomized, placebo controlled studies approximately 50% or more of patients with prostate cancer experienced gynecomastia attributable to various mechanisms. Although it is mostly reported as mild to moderate, gynecomastia is one of the reasons most frequently cited for premature discontinuation of such treatment. Prophylactic radiotherapy and prophylactic tamoxifen have been shown to decrease the incidence of hormone-induced gynecomastia; nevertheless, there are still cases of refractory gynecomastia, and in these plastic surgery is needed for correction.

Gynecomastia is a benign enlargement of the male breast, requiring no treatment unless it is a source of embarrassment and/or distress for the adolescent or man affected. The indications for surgical treatment of gynecomastia are founded on two main objectives: restoration of the male chest shape and diagnostic evaluation of suspected breast lesions. The authors believe that the complete circumareolar technique with no further scarring creates the best aesthetic results with fewer complications. When this is used in combination with liposuction very pleasing aesthetic results can be achieved.

Keywords

Hormone therapy Prostate cancer Gynecomastia Surgical treatment Circumareolar technique Liposuction 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  • H. Ryssel
    • 1
  • G. Germann
    • 1
  • E. Köllensperger
    • 1
  • K. Riedel
    • 1
  1. 1.Klinik für Hand-, Plastische und Rekonstruktive Chirurgie - SchwerbrandverletztenzentrumBerufsgenossenschaftlichen Unfallklinik Ludwigshafen, Plastische und Handchirurgie an der Universität HeidelbergLudwigshafenDeutschland

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