Surgical treatment of primary gynecomastia in children and adolescents.
OBJECTIVE
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.


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).


CONCLUSIONS
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.
Department of Hand-, Plastic and Reconstructive Surgery, BG Trauma Centre Ludwigshafen, Burn Centre, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany, sfischer@hotmail.de.
Sebastian
S
Fischer
Tobias
T
Hirsch
Christoph
C
Hirche
Jurij
J
Kiefer
Maximilian
M
Kueckelhaus
Günter
G
Germann
Matthias A
MA
Reichenberger
D000293:Adolescent; D002648:Child; D006177:Gynecomastia / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D015187:Lipectomy; D008297:Male; D015414:Mastectomy, Subcutaneous; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome