Review Of Adolescent Gynecomastia Does Not Support Routine Pathological Examination, Reviewed by Miguel Delgado, M.D. – Dr. John C. Koshy with the Department of Pathology at Baylor College of Medicine and colleagues from Baylor, the University of Southern California, and The Methodist Hospital System conducted an exhaustive examination of hospital records and literature in search of proof that substantiated the routine pathological examination of subcutaneous tissue removed from adolescents that had gynecomastia. The examination included a review of all relevant literature that has been published in the last 45 years. The study also included a review of the hospital charts and records from three major hospitals in Texas of all adolescent patients that had tissue removed due to gynecomastia. The researchers also examined the records of 61 hospitals across the United States that performed at least one procedure for gynecomastia in the last decade using a survey. The study examined males that were 21 years of age and younger. The research found that the average age at which most adolescent men have a procedure for gynecomastia is 17 years of age. The pathology from the 81 patients that underwent a subcutaneous mastectomy for gynecomastia in the Texas hospitals showed no signs of cancer. The literature review found six instances of cancer and five instances of atypical cell growth in the removed tissue. Only seven of the 615 cases of gynecomastia and subsequent pathology from the literature indicated any signs of any type of carcinoma. The literature review is elucidative in that large samples of patients were rare. Those seven patients that did show signs of cancer or the potential for cancer came from studies of single patients or statistically small groups of patients. An abnormal physical exam indicating possible cancer occurred only once. The response to the survey was 36.1 percent. The hospitals that did respond indicated that pathology tests were considered to be not only routine but mandatory in cases of tissue removed from adolescents that had gynecomastia. The researchers argue that the added cost to the patient or patient’s family for the routine pathological examination of fat tissue removed from adolescents with gynecomastia is not supported by the incidence of cancer detected in a study that spanned 45 years of data. The average additional cost of $1,260 is normally not covered by insurance and is considered to be out-of-pocket for the patient or their family. The researchers argue that the psychological benefit of a procedure to remove excess fat tissue in male adolescents that have gynecomastia is substantial. The researchers cite evidence from the records of the Society for Plastic Surgeons for the years 2000, 2007, and 2008 that indicate that only 0.012 percent of the 19,855 procedures for gynecomastia indicated any potential for cancer. The researchers conclude that routine pathological tests for cancer in gynecomastia procedures are not warranted by the observed incidence of cancer in 45 years of study. The study emphasizes that the cost burden to the Medicare and Medicaid systems for pathology as a routine part of a procedure to remove excess fat in gynecomastia cannot be supported. The study does concede that any request for pathology on the part of the patient or the patient’s family should be honored. Article- Breast Cancer Incidence in Adolescent Males Undergoing Subcutaneous Mastectomy for Gynecomastia: Is Pathologic Examination Justified? A Retrospective and Literature Review Koshy, John C. M.D.; Goldberg, Jonathan S. M.D.; Wolfswinkel, Eric M. B.S.; Ge, Yimin M.D.; Heller, Lior M.D.
You may have heard of gynecomastia. You may even know it from personal experience. It is the enlargement of breasts in men and boys—also referred to as “man boobs.” Although most think of it as abnormal, it actually occurs in about two thirds of puberty-aged boys—usually about 13 or 14 years old, according to endocrinologist Glenn Braunstein. It also occurs frequently in older males, usually after the age of 50.
Gynecomastia can cause physical pain, such as extreme tenderness of the nipple when things such as shirts or towels rub against it. Moreover, it can cause serious emotional stress and anxiety. Teenage boys with gynecomastia may live in fear, taunted or shamed by peers, and constantly comparing themselves to “normal” males.
Gynecomastia is most frequently caused by a hormonal imbalance. Although all men have some amount of estrogen—the hormone that plays a key role in female development—gynecomastia occurs when a male’s body produces too much estrogen. Obesity can also play a role in causing gynecomastia, as it can and often does lead to fat being stored behind the breast. Although gynecomastia can be a symptom of certain cancers or other more serious problems, Braunstein says it should only be a cause for real concern if it develops early, such as in a five-, six-, or seven-year-old.
While most cases show that gynecomastia goes away on in three to six months, there are several treatment options for men and boys who suffer from it. Gynecomastia.org is a vast source of information about the various treatments available. There are medications that help to reduce the pain, and if the condition persists past puberty, then male breast reduction surgery is an option, in which a plastic surgeon can remove the extra tissue.
Braunstein suggests waiting at least a year and a half after the issue manifests before considering surgery. After that point, he says, the breasts may contain scar tissue, in which case the extra tissue would be less likely to go away on its own or respond to available medications. It is important to be sure boys are finished with puberty before undergoing surgery; if the breast tissue is removed before a boy’s body has finished developing, then it is possible that the gynecomastia will return.
If you currently struggle or at any time in the past struggled with gynecomastia, look no farther than gynecomstia.org for a place to give and receive the support that everyone with this condition deserves.
Gynecomastia.org is the world’s best forum and source of information and current news on this common but rarely discussed condition.
Voted the most valuable player for 1974 and 1975, Bernie Parent was inducted into the National Hockey League Hall of Fame in 1984. The famous goalie had a tagline stating “only the Lord saves more than Bernie Parent.” His successful career on the ice ended from an injury to his eye from a hockey stick in 1979.
Who would have guessed that this famous athlete suffered in silence since his teen years with gynecomastia? Unlike most young men, his male breasts did not go away after puberty, and he spent the next 50+ years trying to hide his chest with loose shirts that he never removed in public.
At age 70, Bernie Parent finally had enough humiliation from his man boobs. He has shared his story of how he missed spending time at the beach with his children and grandchildren due to his shame of having male breasts. He hasn’t owned a bathing suit in over 40 years! The last straw was when he didn’t feel comfortable taking his shirt off when out on his boat, he decided it was time to do something about it and sought the advice of a plastic surgeon.
He was happy to learn there is a non-surgical procedure that reduces fat. True gynecomastia is a combination of fat and breast tissue, which requires a surgical procedure combining liposuction and surgical excision. However, pseudo-gynecomastia that is caused mostly by fat might be treated by CoolSculpting.
CoolSculpting can be performed in a medical office under a physician’s supervision. The procedure uses FDA approved cooling technology to reduce layers of fat. It takes several weeks for the results to be evident, but the slow dissipation of the fat cells allows the skin the shrink back naturally leaving a natural looking result.
After two treatments, Bernie was amazed at the difference in his chest. He could go for a third treatment, but is very happy with his results to date. By going public with his story in January 2015 in an article in South Jersey Times, he hopes to help other men avoid the misery he experienced.
Most surgeons take before and after pictures of their patients. Board Certified Plastic Surgeons receive special training in photography due to the importance of this documentation which assists them in surgical planning. Beyond surgical planning, the photographs are a useful tool for surgeons to show prospective patients the quality of their work. Many patients appreciate being able to see their before pictures to compare them to their surgical result.
For a man with gynecomastia, also known as man boobs, searching for a gynecomastia specialist can be daunting. There are many aspects for the man to consider. First, he needs to be sure the surgeon is Board Certified in Plastic Surgery. Second check out where the surgery is to be performed, hospital or surgical center and find out if it is accredited. If it is an accredited surgery center, he should ask for a tour and note if it is organized and clean.
During the consultation, the gynecomastia patient needs to ask lots of questions. Find out how many male breast reduction surgeries are performed per year. Ask the surgeon what method of surgery he or she plans. Unless the man has “pseudo-gynecomastia” (only fat and no excess breast tissue), the combination of liposuction and surgical excision is necessary. Liposuction alone will leave breast tissue behind, necessitating a secondary surgery to remove the breast tissue. In order to remember all your questions, it is advised to bring a list.
Possibly one of the most important aspects to help a man determine the expertise of the gynecomastia surgeon is in the viewing of the surgeons before and after surgery pictures of actual patients.
In viewing the before and after pictures, there are a few things to note that will help determine the accuracy of what you are looking at. There should be different angles taken of each patient; front view, oblique and side view. Almost anything can be made to look good from just one angle. The background should be consistent, a blank wall or a black drape works well. The person needs to be placed in the frame in the same position, with arms down at their sides, or in the same position, for both before and after surgery. In addition, color saturation and lighting needs to be the same or as close as possible, for easier comparison.
Bearing all these things in mind, it is understandable how difficult it can be for a man to choose the best top plastic cosmetic gynecomastia surgeon he can find. The effort will be well worth it, to be able to avoid revision surgery. The single most common cause for the need of a secondary surgery is where the initial surgeon mistakenly thinks that liposuction alone will remove the male breasts of a man with “true gynecomastia”. As mentioned earlier, liposuction will work for the man that has “pseudo-gynecomastia” which is caused by fat alone.
Each case of gynecomastia is unique, while most men have what is considered “true gynecomastia” there are some men with a milder form that offers some options. Men that have “true gynecomastia” usually require both liposuction of fat and surgical excision of the breast gland. This is generally a three to four hour surgical procedure and requires the placing of drains which stay in place for about four days.
Men who have what is referred to as puffy nipples and/or a smaller breast mound of an A or B cup and have good quality skin could potentially be candidates for a less invasive surgery that I refer to as the “light pull through procedure”. It is not a new procedure it has been around for almost twenty years, but it has been perfected through the years with outstanding results.
This procedure differs with traditional gynecomastia surgery in that an endoscope is used. An endoscope is an instrument that is inserted into the body through a small incision of about two to three millimeters at the lateral edge of the areola. The endoscope allows the surgeon to see inside the body via optical fibers that send a picture to a computer monitor. First, fat is removed by liposuction with a cannula through the same small incision. Then, through the same incision the connecting fibers are freed up with a medical instrument that resembles a pickle fork, allowing the glandular tissue to be pulled gently through the incision thus the name “light pull through procedure”.
For my traditional gynecomastia patients, a three millimeter incision is made in the arm pit to remove fat from the chest by liposuction. Then I make an incision around the lower half of the areola to have access to breast tissue for excision. With the incision around the areola where the skin color naturally changes, the scar heals very nicely and usually is not detectable. Once fat and tissue have been removed from the chest a pocket of space is left where fluid can collect, this is referred to as a seroma, different than a hematoma which is a collection of blood from a small artery or vein. To prevent the accumulation of fluid in the pocket I use drains. The drains create a negative pressure encouraging the cavity to close down. In addition, I have my patients wear a compression vest for six weeks. There are several reasons for the vest, for one thing it helps close the pocket of space, reduces swelling and helps the skin to retract.
Contrary to a popular belief that liposuction alone may reduce the male breast, removal of breast tissue is also necessary for a well sculpted outcome. Whether it is by the traditional surgical excision or for those with a minor case who are treated by the “light pull through procedure”, breast tissue must be excised as it is too dense to be removed through the cannula by liposuction. The exception to this would be the patient that has what is known as pseudogynecomastia (which is caused by fat alone).
Since the “light pull through procedure” is so much less invasive, my patients do not require drains. In addition to not needing drains, the other advantages are; the surgical time is less and the recovery time is faster, and with the smaller incision the resulting scar heals to almost invisible.
