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Surgical treatment of primary gynecomastia in children and adolescents

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Abstract

Purpose

Idiopathic gynecomastia is a common diagnosis in children and adolescents. Though medical treatments reveal potentially harmful side effects, surgical interventions are performable in numerous techniques. In children and adolescents, only minimal evidence exists. This retrospective study presents our experiences with two common surgical techniques, namely subcutaneous mastectomy and combination with liposuction.

Patients and methods

This retrospective study included all patients <18 years who underwent surgery due to idiopathic gynecomastia. Height, weight and grade of gynecomastia according to Simon’s classification before surgery were reviewed in all patients’ files. Additionally, duration of surgery, inpatient stay and postoperative complications were documented. Follow-up examinations were performed with assessment of scar formation, numbness and retraction of the nipple region. Furthermore, patients were asked to report on general satisfaction with surgery (satisfactory/not satisfactory) and esthetic outcome on a numeric scale (1 = good, 6 = bad).

Results

37 patients underwent surgery for verified idiopathic gynecomastia. Grade of gynecomastia was I° in 13.5 % (n = 5), II° in 40.5 % (n = 15) and III° in 46 % (n = 17) of cases. Subcutaneous mastectomy was applied in 11 patients (group I, 30 %) and both subcutaneous mastectomy and liposuction in 26 patients (group II, 70.3 %). Postoperative complications occurred in two patients. Long-term follow-up was performed in 32 patients after a median of 34 months (range 6–96 months). Hypertrophic scar formation was seen in one patient (3 %) and nipple retraction in two patients (5 %). Recurrence of gynecomastia occurred in two patients (5 %). Patient rating was satisfactory in 9 % of cases and esthetic outcome was received with a median of 2.0 (1–5). In comparing both surgical techniques, combination of mastectomy and liposuction revealed better results in every measure except for surgical duration (median 73 vs. 90 min).

Conclusion

Surgical correction of gynecomastia remains a purely elective intervention. In contrast to adults, skin in children and adolescents provides high retractability. Therefore, open reduction combined with minimally invasive liposuction was proven useful.

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Authors and Affiliations

  1. Department of Hand-, Plastic and Reconstructive Surgery, BG Trauma Centre Ludwigshafen, Burn Centre, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany

    Sebastian Fischer, Christoph Hirche & Jurij Kiefer

  2. Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Burn Centre, Ruhr University Bochum, Bochum, Germany

    Tobias Hirsch & Maximilian Kueckelhaus

  3. ETHIANUM Clinic for Plastic and Reconstructive Surgery, Aesthetic and Preventive Medicine at Heidelberg University Hospital, Heidelberg, Germany

    Günter Germann & Matthias A. Reichenberger

Authors
  1. Sebastian Fischer
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  2. Tobias Hirsch
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  3. Christoph Hirche
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  4. Jurij Kiefer
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  5. Maximilian Kueckelhaus
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  6. Günter Germann
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  7. Matthias A. Reichenberger
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Correspondence to Sebastian Fischer.

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Fischer, S., Hirsch, T., Hirche, C. et al. Surgical treatment of primary gynecomastia in children and adolescents. Pediatr Surg Int 30, 641–647 (2014). https://doi.org/10.1007/s00383-014-3508-8

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  • DOI: https://doi.org/10.1007/s00383-014-3508-8

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