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Die plastische chirurgische Therapie der Gynäkomastie nach antihormoneller Therapie bei Prostatakarzinom

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

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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.

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.

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Literatur

  1. Abramo AC (1994) Axillary approach for gynecomastia liposuction. Aesthetic Plast Surg 18: 265–268

    Article  PubMed  CAS  Google Scholar 

  2. Aegineta, P (1846) On male breast resembling the female. In: Adams F (ed) The seven books of Paulus Aegineta. Vol. 2, Book 6, Section 46. Sydenham Society, London, pp 334–335

  3. Andel G van, Kurth KH (2003) The impact of androgen deprivation therapy on health related quality of life in asymptomatic men with lymph node positive prostate cancer. Eur Urol 44: 209–214

    Article  PubMed  Google Scholar 

  4. Andersen JA, Gram JB (1982) Male breast at autopsy. Acta Pathol Microbiol Immunol Scand (A) 90: 191–197

    Google Scholar 

  5. Benelli (1990) A new periareolar mammaplasty: the „round block“ technique. Aesthetic Plast Surg 14: 93–100

    Article  PubMed  CAS  Google Scholar 

  6. Botta SA (1998) Alternatives for the surgical correction of severe gynecomastia. Aesthetic Plast Surg 22: 65–70

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  8. Brenner P, Berger A, Schneider W, Axmann HD (1992) Male reduction mammoplasty in serious gynecomastias. Aesthetic Plast Surg 16: 325–330

    Article  PubMed  CAS  Google Scholar 

  9. Castro-Magana M, Angulo M, Uy J (1993) Male hypogonadism with gynecomastia caused by late-onset deficiency of testicular 17-ketosteroid reductase. N Engl J Med 328: 1297–1301

    Article  PubMed  CAS  Google Scholar 

  10. Chodak G, Sharifi R, Kasimis B et al. (1995) Single-agent therapy with bicalutamide: a comparison with medical or surgical castration in the treatment of advanced prostate carcinoma. Urology 46: 849–855

    Article  PubMed  CAS  Google Scholar 

  11. Cianchetti E, Legnini M, Ucchino S et al. (1996) Ginecomastia. Ann Ital Chir 67: 495–500

    PubMed  CAS  Google Scholar 

  12. Denis LJ, Keuppens F, Smith PH et al. (1998) Maximal androgen blockade: final analysis of EORTC phase III trial 30853. EORTC Genito-Urinary Tract Cancer Cooperative Group and the EORTC Data Center. Eur Urol 33: 144–151

    Article  PubMed  CAS  Google Scholar 

  13. Fruhstorfer BH, Malata CM (2003) A systematic approach to the surgical treatment of gynaecomastia. Br J Plast Surg 56: 237–246

    Article  PubMed  CAS  Google Scholar 

  14. Green HJ, Pakenham KI, Headley BC, Gardiner RA (2002) Coping and health-related quality of life in men with prostate cancer randomly assigned to hormonal medication or close monitoring. Psychooncology 11: 401–414

    Article  PubMed  Google Scholar 

  15. Hedlund PO, Henriksson P (2000) Parenteral estrogen versus total androgen ablation in the treatment of advanced prostate carcinoma: effects on overall survival and cardiovascular mortality. The Scandinavian Prostatic Cancer Group (SPCG)-5 Trial Study. Urology 55: 328–333

    Article  PubMed  CAS  Google Scholar 

  16. Hertl MC, Wiebel J, Schafer H et al. (1998) Feminizing Sertoli cell tumors associated with Peutz-Jeghers syndrome: an increasingly recognized cause of prepubertal gynecomastia. Plast Reconstr Surg 102: 1151–1157

    Article  PubMed  CAS  Google Scholar 

  17. Iversen P, Tyrrell CJ, Kaisary AV et al. (2000) Bicalutamide monotherapy compared with castration in patients with nonmetastatic locally advanced prostate cancer: 6.3 years of followup. J Urol 164: 1579–1582

    Article  PubMed  CAS  Google Scholar 

  18. Kornstein AN, Cinelli PB (1992) Inferior pedicle reduction technique for larger forms of gynecomastia. Aesthetic Plast Surg 16: 331–335

    Article  PubMed  CAS  Google Scholar 

  19. Liebau J, Machens HG, Berger A (1998) Gynecomastia of the male nipple. Ann Plast Surg 40: 678–691

    Article  PubMed  CAS  Google Scholar 

  20. Morselli PG (1996) „Pull-through“: a new technique for breast reduction in gynecomastia. Plast Reconstr Surg 97: 450–454

    Article  PubMed  CAS  Google Scholar 

  21. Murphy TP, Ehrlichman RJ, Seckel BR (1994) Nipple placement in simple mastectomy with free nipple grafting for severe gynecomastia. Plast Reconstr Surg 94: 818–823

    Article  PubMed  CAS  Google Scholar 

  22. Nicolis GL, Modlinger RS, Gabrilove JL (1971) A study of the histopathology of human gynecomastia. J Clin Endocrinol Metab 32: 173–178

    Article  PubMed  CAS  Google Scholar 

  23. Ockrim JL, Lalani E-N, Laniado ME et al. (2003) Transdermal estradiol therapy for advanced prostate cancer – forward to the past? J Urol 169: 1735–1737

    Article  PubMed  CAS  Google Scholar 

  24. Ohyama T, Takada A, Fujikawa M, Hosokawa K (1998) Endoscope-assisted transaxillary removal of glandular tissue in gynecomastia. Ann Plast Surg 40: 62–64

    Article  PubMed  CAS  Google Scholar 

  25. Peled IJ (1991) The concentric mastopexy and purse-string suture. Plast Reconstr Surg 87: 385

    Article  PubMed  CAS  Google Scholar 

  26. Physicians‘ Desk Reference (2003) Montvale: Medical Economics

  27. 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: 909–923

    Article  PubMed  Google Scholar 

  28. Samdal F, Kleppe G, Amland PF, Abyholm F (1994) Surgical treatment of gynaecomastia: Five years’ experience with liposuction. Scand J Plast Reconstr Surg Hand Surg 28: 123–130

    Article  PubMed  CAS  Google Scholar 

  29. Simon BE, Hoffman S, Kahn S (1973) Classification and surgical correction of gynecomastia. Plast Reconstr Surg 51: 48–52

    Article  PubMed  CAS  Google Scholar 

  30. Smoot EC III (1998) Eccentric skin resection and purse-string closure for skin reduction with mastectomy for gynecomastia. Ann Plast Surg 41: 378–383

    Article  PubMed  Google Scholar 

  31. Smyth CM, Bremner WJ (1998) Klinefelter syndrome. Arch Intern Med 158: 1309–1314

    Article  PubMed  CAS  Google Scholar 

  32. Stark GB, Grandel S, Spilker G (1992) Tissue suction of the male and female breast. Aesthetic Plast Surg 16: 317–324

    Article  PubMed  CAS  Google Scholar 

  33. Teimourian B, Perlman R (1983) Surgery for gynecomastia. Aesthetic Plast Surg 7: 155–157

    Article  PubMed  CAS  Google Scholar 

  34. Waterfall NB, Glaser MG (1979) A study of the effects of radiation on prevention of gynaecomastia due to oestrogen therapy. Clin Oncol 5: 257–260

    PubMed  CAS  Google Scholar 

  35. Webster JP (1946) Mastectomy for gynecomastia through a semicircular intra-areolar incision. Ann Surg 124: 557–575

    Article  PubMed  CAS  Google Scholar 

  36. Widmark A, Fossa SD, Lundmo P et al. (2003) Does prophylactic breast irradiation prevent antiandrogen-induced gynecomastia? Evaluation of 253 patients in the randomized Scandinavian trial SPCG-7/SFUO-3. Urology 61: 145–151

    Article  PubMed  CAS  Google Scholar 

  37. Williams MJ (1963) Gynecomastia: Its incidence, recognition and host characterization in 447 autopsy cases. Am J Med 34: 103–112

    Article  PubMed  CAS  Google Scholar 

  38. Wilson JD, Aiman J, MacDonald PC (1980) The pathogenesis of gynecomastia. Adv Intern Med 25: 1–32

    PubMed  CAS  Google Scholar 

  39. Wortsman J, Hamidinia A, Winters SJ (1989) Hypogonadism following long-term treatment with diethylstilbestrol. Am J Med Sci 297: 365–368

    Article  PubMed  CAS  Google Scholar 

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  1. Klinik für Hand-, Plastische und Rekonstruktive Chirurgie - Schwerbrandverletztenzentrum, Berufsgenossenschaftlichen Unfallklinik Ludwigshafen, Plastische und Handchirurgie an der Universität Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland

    H. Ryssel, G. Germann, E. Köllensperger & K. Riedel

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  1. H. Ryssel
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  2. G. Germann
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  4. K. Riedel
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Ryssel, H., Germann, G., Köllensperger, E. et al. Die plastische chirurgische Therapie der Gynäkomastie nach antihormoneller Therapie bei Prostatakarzinom. Urologe 47, 467–471 (2008). https://doi.org/10.1007/s00120-007-1567-3

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  • DOI: https://doi.org/10.1007/s00120-007-1567-3

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