Gynecomastia is the growth of the male breast and it can appear in 65% of the patients between I3 and I6 years old. The most common causes are hepatitis or liver cirrosis, lung carcinoma or chronic inflammatory lung disease, testicular disfunction or carcinoma, endocrinologic tumors (pituitary or adrenal glands), alterations of the serum leves of testosterone, genetic syndromes (Klinefelter Syndrome, p.ex.), drug abuse (heroine, marijuana or anabolic steroids) and Hansen Disease. It can be classified according its volume, to the tissues that are enlarged (fat, glandular or both) or to the surgical treatment that is required (small, moderate or severe). The treatment of the larger forms of gynecomastia is very different from that of the less severe forms. In the larger forms, beside the need of ressection of the glandular and/or fat tissues, the surgeon may have to ressec redundant skin and reposition the nipple-areola complex. This paper describes a specific surgical technique for this situation, by using two flaps based on lateral and medial pedicles, with 2cm thickness, that maintain the nutrition of the flaps. The pedicles are limited by dividing the four quadrants of the gynecosmastia with 45 degrees lines, using the nipple as the central point. The epidermis of the redundant skin area seen by the pinch test is then ressected, and the two-layer suture is made. The final scar is periareolar. Twenty patients with severe forms of gynecomastia underwent this surgical procedure. The mean age of 23,3 years old, and six patients had dark skin. The good positioning of the nipple-areola complex and a periareolar scar were the goals. The complications were: assimetry of the nipple-areola complex in two cases, both having severe assimetry on the pre-operative evaluation; one patient with dark skin had a hypertrophic scar; that was treated with intra-lesional applications of triancinolone; partial necroses of the areola occurred in one case, which led to secondary healing with good results; one case of dehiscence of the periareolar suture was observed, which was sutured again, with no further problems. Additionally, four patients had hemato-serous fluid collection, that resolved completely after percutaneous drainage.
Gynecomastia; Treatment; Surgery