Abstract
Background
Asymmetric bilateral gynecomastia (ABGM) is uncommon, and reports on its characteristics are rare. In the present study, we investigated the clinical characteristics and surgical treatment of ABGM.
Methods
We conducted a retrospective study of 1159 patients with gynecomastia who underwent subcutaneous mastectomy with liposuction at Damsoyu Hospital from January 2014 to February 2016. We then analyzed differences in the characteristics and operative results between two groups of patients: those with asymmetric and symmetric gynecomastia. Asymmetric gynecomastia was defined as gynecomastia meeting both of the following criteria: (1) upon physical examination, the size of the palpable mass below the nipple–areolar complex was twice as large as the smaller one, and (2) upon ultrasonography, the depth of the glandular tissue under the nipple-areolar complex was twice as large as the smaller one.
Results
Fifty-four patients were diagnosed with asymmetric gynecomastia. Among them, 51 had ABGM and three had unilateral gynecomastia. In the asymmetric group, more patients had a larger left than right breast (33 patients, 64.7%). The incidence of true-type (entirely glandular) breasts was significantly higher in the asymmetric group (84.3%) than in the symmetric group (p < 0.001). The asymmetry ratios in the asymmetric and symmetric groups were 1.87 ± 2.07 and 0.20 ± 0.16, respectively (p < 0.001).
Conclusion
Bilateral mastectomy provided an acceptable and symmetric cosmetic outcome in patients with ABGM.
Level of Evidence IV
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References
Braunstein GD (2007) Clinical practice. Gynecomastia. N Engl J Med 357:1229–1237
Narula HS, Carlson HE (2014) Gynaecomastia–pathophysiology, diagnosis and treatment. Nat Rev Endocrinol 10:684–698
Johnson RE, Murad MH (2009) Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc 84:1010–1015
Wiesman IM, Lehman JA Jr, Parker MG, Tantri MD, Wagner DS, Pedersen JC (2004) Gynecomastia: an outcome analysis. Ann Plast Surg 53:97–101
Rew L, Young C, Harrison T, Caridi R (2015) A systematic review of literature on psychosocial aspects of gynecomastia in adolescents and young men. J Adolesc 43:206–212
Simon BE, Hoffman S, Kahn S (1973) Classification and surgical correction of gynecomastia. Plast Reconstr Surg 51:48–52
Webster JP (1946) Mastectomy for gynecomastia through a semicircular intra-areolar incision. Ann Surg 124:557–575
Kayar R, Çilengiroğlu OV (2015) Breast volume asymmetry value, ratio, and cancer risk. Breast Cancer (Auckl) 9:87–92
Choi BS, Lee SR, Byun GY, Hwang SB, Koo BH (2017) The characteristics and short-term surgical outcomes of adolescent gynecomastia. Aesthetic Plast Surg 41:1011–1021
Lanitis S, Starren E, Read J, Heymann T, Tekkis P, Hadjiminas DJ, Al Mufti R (2008) Surgical management of gynaecomastia: outcomes from our experience. Breast 17:596–603
Hands LJ, Greenall MJ (1991) Gynaecomastia. Br J Surg 78:907–911
Bannayan GA, Hajdu SI (1972) Gynecomastia: clinicopathologic study of 351 cases. Am J Clin Pathol 57:431–437
Narula HS, Carlson HE (2007) Gynecomastia. Endocrinol Metab Clin North Am 36:497–519
Cordova A, Moschella F (2008) Algorithm for clinical evaluation and surgical treatment of gynaecomastia. J Plast Reconstr Aesthet Surg 61:41–49
Kaptanis S, Parvanta L, Beltran L (2014) Testicular seminoma presenting as unilateral gynecomastia. Breast J 20:424–426
Ferrando J, Grimalt R, Alsina M, Bulla F, Manasievska E (2002) Unilateral gynecomastia induced by treatment with 1 mg of oral finasteride. Arch Dermatol 138:543–544
Al-Qattan M, Hassanain J, Mahmoud S, El-Shayeb A, Tashkandi M, Al-Kattan WM (2005) On the neglected entity of unilateral gynecomastia. Ann Plast Surg 55:255–257
Daniels IR, Layer GT (2001) Gynaecomastia. Eur J Surg 167:885–892
Acknowledgements
We would like to express our gratitude to the research center of Damsoyu Hospital. We also thank Angela Morben, DVM, ELS, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
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The authors declare that they have no conflict of interest.
Ethical Approval
The Institutional Review Board of the Korea National Institute for Bioethics Policy, Seoul, South Korea, approved this study.
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Lee, S.R., Lee, S.G., Byun, G.Y. et al. Clinical Characteristics of Asymmetric Bilateral Gynecomastia: Suggestion of Desirable Surgical Method Based on a Single-Institution Experience. Aesth Plast Surg 42, 708–715 (2018). https://doi.org/10.1007/s00266-018-1102-5
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DOI: https://doi.org/10.1007/s00266-018-1102-5