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

Aesthetic Plastic Surgery volume 37, pages 1012–1022 (2013)Cite this article

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

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Acknowledgments

The authors thank Prof. Giuseppina Caraglia for his technical support and for reviewing the manuscript in English.

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Authors and Affiliations

  1. Department of Orthopedic, Traumatologic, Rehabilitative, and Plastic-Reconstructive Sciences, Second University of Naples, L. Miraglia Square 2, 80138, Naples, Italy

    Giuseppe Andrea Ferraro, Francesco De Francesco, Francesco D’Andrea, Chiara Cataldo & Gianfranco Nicoletti

  2. Department of Pediatrics “F. Fede”, Second University of Naples, Naples, Italy

    Tiziana Romano, Anna Grandone, Emanuele Miraglia del Giudice & Laura Perrone

  3. Department of Clinical and Experimental Medicine “F. Magrassi, A. Lanzara”, Section of Radiology and Radiotherapy, Second University of Naples, Naples, Italy

    Gianluca Gatta & Graziella Di Grezia

Authors
  1. Giuseppe Andrea Ferraro
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  2. Tiziana Romano
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  3. Francesco De Francesco
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  4. Anna Grandone
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  5. Francesco D’Andrea
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  9. Graziella Di Grezia
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  11. Gianfranco Nicoletti
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Correspondence to Giuseppe Andrea Ferraro.

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Ferraro, G.A., Romano, T., De Francesco, F. et al. Management of Prepubertal Gynecomastia in Two Monozygotic Twins With Peutz-Jeghers Syndrome: From Aromatase Inhibitors To Subcutaneous Mastectomy. Aesth Plast Surg 37, 1012–1022 (2013). https://doi.org/10.1007/s00266-013-0188-z

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  • DOI: https://doi.org/10.1007/s00266-013-0188-z

Keywords

  • Anastrozole
  • Gynecomastia
  • Peutz-Jeghers
  • Subcutaneous mastectomy
  • Testicular cancer
  • Ultrasound