title: Gynecomastia: A systematic review.
abstract: BACKGROUND
  Gynecomastia is a common medical problem presenting in nearly a third of the male population. Treatment for gynecomastia can be either pharmacological or surgical. Patients with gynecomastia often experience affected quality-of-life. The aim of this systematic review was to analyze the quality of evidence of the current literature in relation to different treatment modalities and Quality-of-Life in patients with gynecomastia.
  
  
  METHODS
  A systematic search of the literature was performed in PubMed, Medline, Scopus, The Cochrane Library, and SveMed+ in accordance with the PRISMA statement. All searches were undertaken between September-November 2014. The PICOS (patients, intervention, comparator, outcomes, and study design) approach was used to specify inclusion criteria. Methodological quality was graded according to MINORS. Quality of evidence was rated according to GRADE. Data from the included studies were extracted based on study characteristics, participants specifics, type of intervention/treatment, and type of outcome measures into data extraction forms.
  
  
  RESULTS
  A total of 134 abstracts were identified in the literature search. Seventeen studies met inclusion criteria, 14 concerning treatment and three concerning Quality-of-Life. All studies were non-randomised with a high risk of bias and very low quality of evidence according to GRADE.
  
  
  CONCLUSIONS
  Several different surgical methods have been described with good results, minimal scars, and various levels of complications. Traditional surgical excision of glandular tissue combined with liposuction provides most consistent results and a low rate of complications. Pubertal gynecomastia may safely be managed by pharmacological anti-oestrogen treatment.
authors.affiliation: a 1 Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital , Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Fagerlund
authors.affiliation: a 1 Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital , Sweden.
authors.forename: Richard
authors.initials: R
authors.lastname: Lewin
authors.affiliation: a 1 Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital , Sweden.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Rufolo
authors.affiliation: a 1 Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital , Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Elander
authors.affiliation: b 2 Plastic Surgery Unit, Sant'Andrea Hospital, "Sapienza" University , Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Santanelli di Pompeo
authors.affiliation: a 1 Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital , Sweden.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
mesh_terms: D000368:Aged; D004954:Esthetics; D019317:Evidence-Based Medicine; D006177:Gynecomastia / Q000175:diagnosis* / Q000523:psychology / Q000601:surgery*; D006801:Humans; D015187:Lipectomy / Q000379:methods; D008297:Male; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013518:Surgery, Plastic / Q000379:methods*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods
keywords: Breast; plastic surgery