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Chirurgische Therapie bei Gynäkomastie

Surgical therapy of gynecomastia

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Zusammenfassung

Die chirurgische Intervention bei der persistierenden ideopathischen Gynäkomastie hat einen hohen Stellenwert im Behandlungsschema eingenommen. Die Wahl der jeweiligen chirurgischen Therapie stützt sich dabei auf den Ausgangsbefund und die Diagnose. Vor der Indikationsstellung zur operativen Therapie ist die Differenzialdiagnostik interdisziplinär hinsichtlich der Pathogenese vollständig aufzuarbeiten. Die Liposuktion wird zunehmend bei der chirurgischen Behandlung der Gynäkomastie verwandt. Sie kann gut mit den traditionellen Techniken wie der subkutanen Mastektomie und der periareolären Straffung kombiniert werden und zeigt ihre Rechtfertigung insbesondere bei der Gynäkomastie Grad IIa/b als narbensparende und komplikationsarme Methode mit sehr guten ästhetischen Reduktionsergebnissen.

In unserem Zentrum wurden in den Jahren 2000 bis 2010 162 Patienten mit Gynäkomastie Grad I–III nach Simon operiert und retrospektiv ausgewertet. Es zeigte sich ein Rückgang der T-Schnitt-Reduktion und der subkutanen Mastektomie kombiniert mit periareolärer Straffung gegenüber einer Zunahme der subkutanen Mastektomie in Kombination mit der Liposuktion.

Zum Ausschluss eines Malignoms sollte immer eine Exzision der Drüse mit histologischer Untersuchung erfolgen.

Abstract

Nowadays surgical intervention is an essential part of the treatment of idiopathic gynecomastia. Choosing the right method is crucial and is based on the current status in the clinical and histological evaluation. Before finalizing the process of choosing a specific method a prior interdisciplinary evaluation of the patient is necessary to ascertain clear indications for a surgical intervention. Liposuction is one of the methods which have become popular in recent years. The advantages are the possible combination with traditional techniques, such as subcutaneous mastectomy or periareolar mastopexy. The main indication is for gynecomastia stage IIa/b and is justifiable due to the reduction in surgical complications and scarring. Furthermore this technique provides an excellent aesthetical outcome for the patient.

A total of 162 patients suffering from gynecomastia stages I–III (according to Simon) were surgically treated between 2000 and 2010 and these cases were retrospectively evaluated. The results showed a decline in the use of a T-shaped incision in combination with subcutaneous mastectomy with periareolar tightening compared to an increase in the use of subcutaneous mastectomy in combination with liposuction.

The excised tissue should always be sent for histological examination to make sure no malignant cells were present.

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Authors and Affiliations

  1. Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Brandverletztenzentrum Niedersachsen, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    A. Heckmann, P.M. Vogt & A. Steiert

  2. INSERM (French National Institute of Health and Medical Research) U703, Lille University Hospital, Loos, France

    F.M. Leclère

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  1. A. Heckmann
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  2. F.M. Leclère
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  3. P.M. Vogt
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  4. A. Steiert
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Correspondence to A. Heckmann.

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Heckmann, A., Leclère, F., Vogt, P. et al. Chirurgische Therapie bei Gynäkomastie. Chirurg 82, 789–796 (2011). https://doi.org/10.1007/s00104-011-2109-5

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  • DOI: https://doi.org/10.1007/s00104-011-2109-5

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