Gynecomastia: an uncommon, destabilizing condition of the male adolescent. our therapeutic choice
Main Article Content
Keywords
Gynecomastia, Primary ginecomastia
Abstract
Gynecomastia is the benign enlargement of breast’s the glandular tissue in male population. Gynecomastia can involve fatty and/or glandular tissue. At the basis of pediatric gynecomastia there is a multifactorial imbalance in the ratio of estrogen to androgens tissue levels. In more than 95% of the cases gynecomastia development is idiopathic. Secondary causes of gynecomastia in adolescents are relatively rare (less than 5%) and may arise from uncommon pathological conditions. Gynecomastia is self-limited and regresses in 1-3 years in 84%, 47% and 20% of adolescents with mild, moderate and severe gynecomastia. The correct first line of therapy is observation and reassurance in the treatment of mild cases. In order to manage adolescent gynecomastia is advised to adopt a tailored therapy. Despite gynecomastia is a common condition only few adolescents need cosmetic or antalgic treatment. Medical therapy should be considered in patient with emotional distress or psychological limitation on normal activities. Finally, if gynecomastia does not go in remission after two years surgical procedures should be performed. The aim of this article is to be an updated discussion of pubertal gynecomastia in every way and report our surgical experience with a retrospective study. In conclusion surgical treatment of this condition is a quiet rare procedure but, in according to global literature we demonstrated that it is a safe surgery with low rate of complications.
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References
1. Braunstein GD. Gynecomastia. N Engl J Med. 2007;357(12):1229-1237. doi:10.1056/NEJMcp070677
2. Coopey SB, Kartal K, Li C, et al. Atypical ductal hyperplasia in men with gynecomastia: what is their breast cancer risk? Breast Cancer Res Treat. 2019;175(1):1-4. doi:10.1007/s10549-018-05117-4
3. Rahmani S, Turton P, Shaaban A, Dall B. Overview of Gynecomastia in the Modern Era and the Leeds Gynaecomastia Investigation Algorithm. Breast J. 2011;17(3):246-255. doi:10.1111/j.1524-4741.2011.01080.x
4. Waltho D, Hatchell A, Thoma A. Gynecomastia Classification for Surgical Management. Plast Reconstr Surg. 2017;139(3):638e-648e. doi:10.1097/PRS.0000000000003059
5. Choi BS, Lee SR, Byun GY, Hwang SB, Koo BH. The Characteristics and Short-Term Surgical Outcomes of Adolescent Gynecomastia. Aesthetic Plast Surg. 2017;41(5):1011-1021. doi:10.1007/s00266-017-0886-z
6. Kumanov P, Deepinder F, Robeva R, Tomova A, Li J, Agarwal A. Relationship of Adolescent Gynecomastia with Varicocele and Somatometric Parameters: A Cross-Sectional Study in 6200 Healthy Boys. J Adolesc Heal. 2007;41(2):126-131. doi:10.1016/j.jadohealth.2007.03.010
7. Lee EJ, Chang YW, Oh JH, Hwang J, Hong SS, Kim HJ. Breast lesions in children and adolescents: Diagnosis and management. Korean J Radiol. 2018;19(5):978-991. doi:10.3348/kjr.2018.19.5.978
8. Amalfi A, Sommer N. Gynecomastia. In: Chung KC, ed. Grabb and Smith’s Plastic Surgery. Eight edit. Wolters Kluwer; 2020:575-581.
9. Narula HS, Carlson HE. Gynaecomastia—pathophysiology, diagnosis and treatment. Nat Rev Endocrinol. 2014;10(11):684-698. doi:10.1038/nrendo.2014.139
10. Soliman AT, De Sanctis V, Yassin M. Management of Adolescent Gynecomastia: An Update. Acta Biomed. 2017;88(2):204-213. doi:10.23750/abm.v88i2.6665
11. Moore DC, Schlaepfer L V., Paunier L, Sizonenko PC. Hormonal Changes during Puberty: V. Transient Pubertal Gynecomastia: Abnormal Androgen-Estrogen Ratios*. J Clin Endocrinol Metab. 1984;58(3):492-499. doi:10.1210/jcem-58-3-492
12. Bidlingmaier F, Knorr D. Plasma testosterone and estrogens in pubertal gynecomastia. Zeitschrift f�r Kinderheilkd. 1973;115(1):89-94. doi:10.1007/BF00438995
13. Dejager S, Bry-Gauillard H, Bruckert E, et al. A Comprehensive Endocrine Description of Kennedy’s Disease Revealing Androgen Insensitivity Linked to CAG Repeat Length. J Clin Endocrinol Metab. 2002;87(8):3893-3901. doi:10.1210/jcem.87.8.8780
14. Gill S, Peston D, Vonderhaar BK, Shousha S. Expression of prolactin receptors in normal, benign, and malignant breast tissue: an immunohistological study. J Clin Pathol. 2001;54(12):956-960. doi:10.1136/jcp.54.12.956
15. Gutzman JH, Miller KK, Schuler LA. Endogenous human prolactin and not exogenous human prolactin induces estrogen receptor α and prolactin receptor expression and increases estrogen responsiveness in breast cancer cells. J Steroid Biochem Mol Biol. 2004;88(1):69-77. doi:10.1016/j.jsbmb.2003.10.008
16. Czajka-Oraniec I, Zgliczyński W. Phenotype of patients with gynecomastia. Endokrynol Pol. 2008;59(2):131-139.
17. Yüce Ö, Tepe D, Erel Ö. Impaired dynamic thiol/disulfide homeostasis in pubertal gynecomastia. Int J Adolesc Med Health. November 2018. doi:10.1515/ijamh-2018-0062
18. Rosen H, Webb ML, DiVasta AD, et al. Adolescent Gynecomastia: not only an obesity issue. Ann Plast Surg. April 2010:1. doi:10.1097/SAP.0b013e3181dba827
19. Freeman RM. Gynecomastia: An Endocrinologic Complication of Hemodialysis. Ann Intern Med. 1968;69(1):67. doi:10.7326/0003-4819-69-1-67
20. Shahriari M, Ghasemi K, Bordbar M, Shakibazad N. Gynecomastia as a late complication of childhood cancer and its treatment that can affect the quality of life of male survivors. Semin Oncol. 2019;46(2):155-159. doi:10.1053/j.seminoncol.2019.04.003
21. Nishiyama M, Makino S, Iwasaki Y, et al. CRH mRNA expression in the hypothalamic paraventricular nucleus is inhibited despite the activation of the hypothalamo-pituitary-adrenal axis during starvation. Brain Res. 2008;1228:107-112. doi:10.1016/j.brainres.2008.06.065
22. Swerdloff RS, Ng CM. Gynecomastia: Etiology, Diagnosis, and Treatment.; 2000. http://www.ncbi.nlm.nih.gov/pubmed/25905330.
23. Pacyński, A., Budzyńska, A., Przylecki, S.J., & Robaczyński J. [Hyperestrogenism in pharmaceutical factory workers and their children as an occupational disease]. Endokrynol Pol. 1971;22(2):149-154.
24. Sansone A, Romanelli F, Sansone M, Lenzi A, Di Luigi L. Gynecomastia and hormones. Endocrine. 2017;55(1):37-44. doi:10.1007/s12020-016-0975-9
25. Kulshreshtha B, Arpita A, Rajesh P, et al. Adolescent gynecomastia is associated with a high incidence of obesity, dysglycemia, and family background of diabetes mellitus. Indian J Endocrinol Metab. 2017;21(1):160. doi:10.4103/2230-8210.196022
26. Yazici M, Sahin M, Bolu E, et al. Evaluation of breast enlargement in young males and factors associated with gynecomastia and pseudogynecomastia. Ir J Med Sci. 2010;179(4):575-583. doi:10.1007/s11845-009-0345-1
27. Dundar B, Dundar N, Erci T, Bober E, Büyükgebiz A. Leptin Levels in Boys with Pubertal Gynecomastia. J Pediatr Endocrinol Metab. 2005;18(10). doi:10.1515/JPEM.2005.18.10.929
28. Dieudonné M-N, Sammari A, Dos Santos E, Leneveu M-C, Giudicelli Y, Pecquery R. Sex steroids and leptin regulate 11β-hydroxysteroid dehydrogenase I and P450 aromatase expressions in human preadipocytes: Sex specificities. J Steroid Biochem Mol Biol. 2006;99(4-5):189-196. doi:10.1016/j.jsbmb.2006.01.007
29. Eren E, Edgunlu T, Korkmaz HA, et al. Genetic variants of estrogen beta and leptin receptors may cause gynecomastia in adolescent. Gene. 2014;541(2):101-106. doi:10.1016/j.gene.2014.03.013
30. Catalano S, Mauro L, Marsico S, et al. Leptin Induces, via ERK1/ERK2 Signal, Functional Activation of Estrogen Receptor α in MCF-7 Cells. J Biol Chem. 2004;279(19):19908-19915. doi:10.1074/jbc.M313191200
31. Fusco R, Galgani M, Procaccini C, et al. Cellular and molecular crosstalk between leptin receptor and estrogen receptor-α in breast cancer: molecular basis for a novel therapeutic setting. Endocr Relat Cancer. 2010;17(2):373-382. doi:10.1677/ERC-09-0340
32. Lorek M, Tobolska-Lorek D, Kalina-Faska B, Januszek-Trzciakowska A, Gawlik A. Clinical and Biochemical Phenotype of Adolescent Males with Gynecomastia. J Clin Res Pediatr Endocrinol. 2019;11(4):388-394. doi:10.4274/jcrpe.galenos.2019.2019.0027
33. Monarca C, Rizzo MI. Gynecomastia. Plast Reconstr Surg. 2013;131(5):863e-865e. doi:10.1097/PRS.0b013e318287a18f
34. Bannayan GA, Hajdu SI. Gynecomastia: Clinicopathologic Study of 351 Cases. Am J Clin Pathol. 1972;57(4):431-437. doi:10.1093/ajcp/57.4.431
35. Li C-C, Fu J-P, Chang S-C, Chen T-M, Chen S-G. Surgical Treatment of Gynecomastia. Ann Plast Surg. 2012;69(5):510-515. doi:10.1097/SAP.0b013e318222834d
36. Sollie M. Management of gynecomastia—changes in psychological aspects after surgery—a systematic review. Gland Surg. 2018;7(S1):S70-S76. doi:10.21037/gs.2018.03.09
37. Ordaz DL, Thompson JK. Gynecomastia and psychological functioning: A review of the literature. Body Image. 2015;15:141-148. doi:10.1016/j.bodyim.2015.08.004
38. Nuzzi LC, Cerrato FE, Erikson CR, et al. Psychosocial impact of adolescent gynecomastia: A prospective case-control study. Plast Reconstr Surg. 2013;131(4):890-896. doi:10.1097/PRS.0b013e3182818ea8
39. Kinsella, C., Jr., Landfair, A., Rottgers, S. A., Cray, J. J., Weidman, C., Deleyiannis, F. W. B.,. . .& Losee JE. The psychological burden of idiopathic adolescent gynecomastia. Plast Reconstr Surg. 2012;129(1-7). doi:10. 1097/prs.0b013e3182361efd
40. March JS, Parker JDA, Sullivan K, Stallings P, Conners CK. The Multidimensional Anxiety Scale for Children (MASC): Factor Structure, Reliability, and Validity. J Am Acad Child Adolesc Psychiatry. 1997;36(4):554-565. doi:10.1097/00004583-199704000-00019
41. Schonfeld WA. Gynecomastia in Adolescence: Effect on Body Image and Personality Adaptation. Psychosom Med. 1962;24(4):379-389. doi:10.1097/00006842-196200700-00008
42. Money J, Lewis V. Homosexual/Heterosexual status in boys at puberty: idiopathic adolescent gynecomastia and congenital virilizing adrenocorticism compared☆. Psychoneuroendocrinology. 1982;7(4):339-346. doi:10.1016/0306-4530(82)90037-3
43. Telegrafo M, Introna T, Coi L, et al. Breast US as primary imaging modality for diagnosing gynecomastia. G di Chir. 2016;37(3):118-122. doi:10.11138/gchir/2016.37.3.118
44. McArthur JW, Toll GD, Russfield AB, Reiss AM, Quinby WC, Baker WH. Sexual precocity attributable to ectopic gonadotropin secretion by hepatoblastoma. Am J Med. 1973;54(3):390-403. doi:10.1016/0002-9343(73)90034-X
45. Fauci, Anthony; Kasper, Dennis; Hauser, Stephen; Longo, Dan; Jameson, Larry; Loscalzo J. Harrison- Manuale Di Medicina. XIX 2017. (: Casa Editrice Ambrosiana, ed.).; 2017.
46. Kanakis GA, Nordkap L, Bang AK, et al. EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology. 2019;7(6):778-793. doi:10.1111/andr.12636
47. Castro-Magana M, Angulo M, Uy J. Male Hypogonadism with Gynecomastia Caused by Late-Onset Deficiency of Testicular 17-Ketosteroid Reductase. N Engl J Med. 1993;328(18):1297-1301. doi:10.1056/NEJM199305063281802
48. Pusl T, Stoemmer P. Gynecomastia: Look Beyond the Obvious. Am J Med. 2017;130(10):e439-e440. doi:10.1016/j.amjmed.2017.04.021
49. Rehman T, Hameed A, Beharry N, Parcq J Du, Bano G. An unusual cause of gynaecomastia in a male. Endocrinol Diabetes Metab Case Reports. 2019;2019. doi:10.1530/EDM-19-0060
50. Lazala C, Saenger P. Pubertal Gynecomastia. J Pediatr Endocrinol Metab. 2002;15(5). doi:10.1515/JPEM.2002.15.5.553
51. Malhotra AK, Amed S, Bucevska M, Bush KL, Arneja JS. Do adolescents with gynecomastia require routine evaluation by endocrinology? Plast Reconstr Surg. 2018;142(1):9E-16E. doi:10.1097/PRS.0000000000004465
52. Diamantopoulos S, Bao Y. Gynecomastia and Premature Thelarche: A Guide for Practitioners. Pediatr Rev. 2007;28(9):e57-e68. doi:10.1542/pir.28-9-e57
53. Nordt CA, DiVasta AD. Gynecomastia in adolescents. Curr Opin Pediatr. 2008;20(4):375-382. doi:10.1097/MOP.0b013e328306a07c
54. Osborne CK. Tamoxifen in the Treatment of Breast Cancer. Wood AJJ, ed. N Engl J Med. 1998;339(22):1609-1618. doi:10.1056/NEJM199811263392207
55. Shahbaz K. Tamoxifen: Pharmacokinetics and Pharmacodynamics. Open Access J Pharm Res. 2017;1(8). doi:10.23880/OAJPR-16000143
56. Lapid O, van Wingerden JJ, Perlemuter L. Tamoxifen therapy for the management of pubertal gynecomastia: a systematic review. J Pediatr Endocrinol Metab. 2013;26(9-10). doi:10.1515/jpem-2013-0052
57. Devoto C E, Madariaga A M, Lioi C X, Mardones N. Terapia médica de la ginecomastia con tamoxifeno. Influencia del volumen y duración de la ginecomastia en el resultado terapéutico. Rev Med Chil. 2007;135(12). doi:10.4067/S0034-98872007001200009
58. Akgül S, Kanbur N, Güçer Ş, Şafak T, Derman O. The histopathological effects of tamoxifen in the treatment of pubertal gynecomastia. J Pediatr Endocrinol Metab. 2012;25(7-8). doi:10.1515/jpem-2012-0105
59. Derman O, Kanbur N, Kılıç I, Kutluk T. Long-term Follow-up of Tamoxifen Treatment in Adolescents with Gynecomastia. J Pediatr Endocrinol Metab. 2008;21(5). doi:10.1515/JPEM.2008.21.5.449
60. Chen Y, Jia X, Chen J, Wang J, Hu M. The Pharmacokinetics of Raloxifene and Its Interaction with Apigenin in Rat. Molecules. 2010;15(11):8478-8487. doi:10.3390/molecules15118478
61. Lawrence SE, Arnold Faught K, Vethamuthu J, Lawson ML. Beneficial effects of raloxifene and tamoxifen in the treatment of pubertal gynecomastia. J Pediatr. 2004;145(1):71-76. doi:10.1016/j.jpeds.2004.03.057
62. Riepe FG, Baus I, Wiest S, Krone N, Sippell WG, Partsch C-J. Treatment of Pubertal Gynecomastia with the Specific Aromatase Inhibitor Anastrozole. Horm Res Paediatr. 2004;62(3):113-118. doi:10.1159/000079882
63. Plourde P V., Reiter EO, Jou H-C, et al. Safety and Efficacy of Anastrozole for the Treatment of Pubertal Gynecomastia: A Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Endocrinol Metab. 2004;89(9):4428-4433. doi:10.1210/jc.2004-0082
64. Beck W, Stubbe P. Endocrinological Studies of the Hypothalamo-Pituitary Gonadal Axis during Danazol Treatment in Pubertal Boys with Marked Gynecomastia. Horm Metab Res. 1982;14(12):653-657. doi:10.1055/s-2007-1019110
65. Ting, AC; Chow, LW; Leung Y. Comparison of tamoxifen with danazol in the management of idiopathic gynecomastia. Am Surg. 2000;66(1):38-40.
66. Plourde P V. Clomiphene in the Treatment of Adolescent Gynecomastia. Am J Dis Child. 1983;137(11):1080. doi:10.1001/archpedi.1983.02140370040013
67. Zachmann M, Eiholzer U, Muritano M, Werder EA, Manella B. Treatment of pubertal gynaecomastia with testolactone. Acta Endocrinol (Copenh). 1986;113(4_Suppl):S218-S226. doi:10.1530/acta.0.112S218
68. Kasielska-Trojan A, Antoszewski B. Gynecomastia Surgery-Impact on Life Quality: A Prospective Case-Control Study. Ann Plast Surg. 2018;80(2):194. doi:10.1097/SAP.0000000000001173
69. Fagerlund A, Lewin R, Rufolo G, Elander A, Santanelli di Pompeo F, Selvaggi G. Gynecomastia: A systematic review. J Plast Surg Hand Surg. 2015;49(6):311-318. doi:10.3109/2000656X.2015.1053398
70. Tu L-C, Tung K-Y, Chen H-C, Huang W-C, Hsiao H-T. Eccentric Mastectomy and Zigzag Periareolar Incision for Gynecomastia. Aesthetic Plast Surg. 2009;33(4):549-554. doi:10.1007/s00266-008-9285-9
71. Rohrich RJ, Ha RY, Kenkel JM, Adams WP. Classification and Management of Gynecomastia: Defining the Role of Ultrasound-Assisted Liposuction. Plast Reconstr Surg. 2003;111(2):909-923. doi:10.1097/01.PRS.0000042146.40379.25
72. Abdelrahman I, Steinvall I, Mossaad B, Sjoberg F, Elmasry M. Evaluation of Glandular Liposculpture as a Single Treatment for Grades I and II Gynaecomastia. Aesthetic Plast Surg. 2018;42(5):1222-1230. doi:10.1007/s00266-018-1118-x
73. Cely AMG, Triana CE, Triana LM. Thorax masculinization in a transsexual patient: Inferior pedicle mastectomy without an inverted T scar. Arch Plast Surg. 2019;46(3):262-266. doi:10.5999/aps.2018.00108
74. Moon J-E, Ko CW, Yang JD, Lee JS. Combined surgical and medical treatment in an adolescent with severe gynecomastia due to excessive estradiol secretion: a case report. BMC Pediatr. 2019;19(1):515. doi:10.1186/s12887-019-1887-7
75. Kim DH, Byun IH, Lee WJ, Rah DK, Kim JY, Lee DW. Surgical Management of Gynecomastia: Subcutaneous Mastectomy and Liposuction. Aesthetic Plast Surg. 2016;40(6):877-884. doi:10.1007/s00266-016-0705-y
76. Yao Y, Yang Y, Liu J, Wang Y, Zhao Y. Vacuum-assisted minimally invasive surgery—An innovative method for the operative treatment of gynecomastia. Surgery. 2019;166(5):934-939. doi:10.1016/j.surg.2019.04.032
77. Tarallo M, Di Taranto G, Fallico N, Ribuffo D. The round-the-clock technique for correction of gynecomastia. Arch Plast Surg. 2019;46(3):221-227. doi:10.5999/aps.2018.00472
78. Qutob O, Elahi B, Garimella V, Ihsan N, Drew P. Minimally invasive excision of gynaecomastia – a novel and effective surgical technique. Ann R Coll Surg Engl. 2010;92(3):198-200. doi:10.1308/003588410X12628812458815
79. Harinatha S. Male Gynecomastia Correction by Superior Dynamic Flap Method: A Consistent and Versatile Technique. World J Plast Surg. 2020;9(1):33-38. doi:10.29252/wjps.9.1.33
80. Arora Y, Mittal RR, Williams EA, Thaller SR. Barriers to the Effective Management of Gynecomastia in Adolescents. J Craniofac Surg. 2019;30(8):2381-2384. doi:10.1097/SCS.0000000000005999
81. Murugesan L, Karidis A. External Quilting: New Technique to Avoid Haematoma in Gynaecomastia Surgery. Aesthetic Plast Surg. 2020;44(1):45-51. doi:10.1007/s00266-019-01537-9
82. Jackson PC, MacInnes EG, Nicholson JK, Brayshaw I, Relton S, Achuthan R. Mastectomy Without Drains Reduces Cost with No Detriment to Patient Outcome. Cureus. 2019;11(7):e5160. doi:10.7759/cureus.5160
83. Keskin M, Sutcu M, Cigsar B, Karacaoglan N. Necessity of Suction Drains in Gynecomastia Surgery. Aesthetic Surg J. 2014;34(4):538-544. doi:10.1177/1090820X14526598
84. Chao JW, Raveendran JA, Maly C, Rogers G, Boyajian M, Oh AK. Closed-Suction Drains After Subcutaneous Mastectomy for Gynecomastia: Do They Reduce Complications? Aesthetic Plast Surg. 2017;41(6):1291-1294. doi:10.1007/s00266-017-0959-z
85. Hansdorfer-Korzon R, Teodorczyk J, Gruszecka A, Lass P. Are compression corsets beneficial for the treatment of breast cancer-related lymphedema? New opportunities in physiotherapy treatment – a preliminary report. Onco Targets Ther. April 2016:2089. doi:10.2147/OTT.S100120
86. Rosen H, Webb ML, DiVasta AD, et al. Adolescent Gynecomastia. Ann Plast Surg. April 2010:1. doi:10.1097/SAP.0b013e3181dba827
87. Bembo SA, Carlson HE. Gynecomastia: its features, and when and how to treat it. Cleve Clin J Med. 2004;71(6):511-517. doi:10.3949/ccjm.71.6.511
88. Al-Allak A, Govindarajulu S, Shere M, Ibrahim N, Sahu AK, Cawthorn SJ. Gynaecomastia: A decade of experience. Surg. 2011;9(5):255-258. doi:10.1016/j.surge.2010.10.004
89. Dialani V, Baum J, Mehta TS. Sonographic Features of Gynecomastia. J Ultrasound Med. 2010;29(4):539-547. doi:10.7863/jum.2010.29.4.539
90. Hines SL, Yasrebi M, Tan WW, Perez EA, DePeri ER. The Role of Mammography in Male Patients With Breast Symptoms. Mayo Clin Proc. 2007;82(3):297-300. doi:10.4065/82.3.297
91. Jones DJ, Holt SD, Surtees P, Davison DJ, Coptcoat MJ. A comparison of danazol and placebo in the treatment of adult idiopathic gynaecomastia: results of a prospective study in 55 patients. Ann R Coll Surg Engl. 1990;72(5):296-298. http://www.ncbi.nlm.nih.gov/pubmed/2221763.
92. Lemaine V, Cayci C, Simmons P, Petty P. Gynecomastia in Adolescent Males. Semin Plast Surg. 2013;27(01):056-061. doi:10.1055/s-0033-1347166
93. Longheu A, Medas F, Corrias F, et al. Surgical management of gynecomastia: Experience of a general surgery center. G di Chir. 2016;37(4):150-154. doi:10.11138/gchir/2016.37.4.150
94. Cordova A, Moschella F. Algorithm for clinical evaluation and surgical treatment of gynaecomastia. J Plast Reconstr Aesthetic Surg. 2008;61(1):41-49. doi:10.1016/j.bjps.2007.09.033
95. Olsson H, Bladstrom A, Alm P. Male gynecomastia and risk for malignant tumours – a cohort study. BMC Cancer. 2002;2(1):26. doi:10.1186/1471-2407-2-26
2. Coopey SB, Kartal K, Li C, et al. Atypical ductal hyperplasia in men with gynecomastia: what is their breast cancer risk? Breast Cancer Res Treat. 2019;175(1):1-4. doi:10.1007/s10549-018-05117-4
3. Rahmani S, Turton P, Shaaban A, Dall B. Overview of Gynecomastia in the Modern Era and the Leeds Gynaecomastia Investigation Algorithm. Breast J. 2011;17(3):246-255. doi:10.1111/j.1524-4741.2011.01080.x
4. Waltho D, Hatchell A, Thoma A. Gynecomastia Classification for Surgical Management. Plast Reconstr Surg. 2017;139(3):638e-648e. doi:10.1097/PRS.0000000000003059
5. Choi BS, Lee SR, Byun GY, Hwang SB, Koo BH. The Characteristics and Short-Term Surgical Outcomes of Adolescent Gynecomastia. Aesthetic Plast Surg. 2017;41(5):1011-1021. doi:10.1007/s00266-017-0886-z
6. Kumanov P, Deepinder F, Robeva R, Tomova A, Li J, Agarwal A. Relationship of Adolescent Gynecomastia with Varicocele and Somatometric Parameters: A Cross-Sectional Study in 6200 Healthy Boys. J Adolesc Heal. 2007;41(2):126-131. doi:10.1016/j.jadohealth.2007.03.010
7. Lee EJ, Chang YW, Oh JH, Hwang J, Hong SS, Kim HJ. Breast lesions in children and adolescents: Diagnosis and management. Korean J Radiol. 2018;19(5):978-991. doi:10.3348/kjr.2018.19.5.978
8. Amalfi A, Sommer N. Gynecomastia. In: Chung KC, ed. Grabb and Smith’s Plastic Surgery. Eight edit. Wolters Kluwer; 2020:575-581.
9. Narula HS, Carlson HE. Gynaecomastia—pathophysiology, diagnosis and treatment. Nat Rev Endocrinol. 2014;10(11):684-698. doi:10.1038/nrendo.2014.139
10. Soliman AT, De Sanctis V, Yassin M. Management of Adolescent Gynecomastia: An Update. Acta Biomed. 2017;88(2):204-213. doi:10.23750/abm.v88i2.6665
11. Moore DC, Schlaepfer L V., Paunier L, Sizonenko PC. Hormonal Changes during Puberty: V. Transient Pubertal Gynecomastia: Abnormal Androgen-Estrogen Ratios*. J Clin Endocrinol Metab. 1984;58(3):492-499. doi:10.1210/jcem-58-3-492
12. Bidlingmaier F, Knorr D. Plasma testosterone and estrogens in pubertal gynecomastia. Zeitschrift f�r Kinderheilkd. 1973;115(1):89-94. doi:10.1007/BF00438995
13. Dejager S, Bry-Gauillard H, Bruckert E, et al. A Comprehensive Endocrine Description of Kennedy’s Disease Revealing Androgen Insensitivity Linked to CAG Repeat Length. J Clin Endocrinol Metab. 2002;87(8):3893-3901. doi:10.1210/jcem.87.8.8780
14. Gill S, Peston D, Vonderhaar BK, Shousha S. Expression of prolactin receptors in normal, benign, and malignant breast tissue: an immunohistological study. J Clin Pathol. 2001;54(12):956-960. doi:10.1136/jcp.54.12.956
15. Gutzman JH, Miller KK, Schuler LA. Endogenous human prolactin and not exogenous human prolactin induces estrogen receptor α and prolactin receptor expression and increases estrogen responsiveness in breast cancer cells. J Steroid Biochem Mol Biol. 2004;88(1):69-77. doi:10.1016/j.jsbmb.2003.10.008
16. Czajka-Oraniec I, Zgliczyński W. Phenotype of patients with gynecomastia. Endokrynol Pol. 2008;59(2):131-139.
17. Yüce Ö, Tepe D, Erel Ö. Impaired dynamic thiol/disulfide homeostasis in pubertal gynecomastia. Int J Adolesc Med Health. November 2018. doi:10.1515/ijamh-2018-0062
18. Rosen H, Webb ML, DiVasta AD, et al. Adolescent Gynecomastia: not only an obesity issue. Ann Plast Surg. April 2010:1. doi:10.1097/SAP.0b013e3181dba827
19. Freeman RM. Gynecomastia: An Endocrinologic Complication of Hemodialysis. Ann Intern Med. 1968;69(1):67. doi:10.7326/0003-4819-69-1-67
20. Shahriari M, Ghasemi K, Bordbar M, Shakibazad N. Gynecomastia as a late complication of childhood cancer and its treatment that can affect the quality of life of male survivors. Semin Oncol. 2019;46(2):155-159. doi:10.1053/j.seminoncol.2019.04.003
21. Nishiyama M, Makino S, Iwasaki Y, et al. CRH mRNA expression in the hypothalamic paraventricular nucleus is inhibited despite the activation of the hypothalamo-pituitary-adrenal axis during starvation. Brain Res. 2008;1228:107-112. doi:10.1016/j.brainres.2008.06.065
22. Swerdloff RS, Ng CM. Gynecomastia: Etiology, Diagnosis, and Treatment.; 2000. http://www.ncbi.nlm.nih.gov/pubmed/25905330.
23. Pacyński, A., Budzyńska, A., Przylecki, S.J., & Robaczyński J. [Hyperestrogenism in pharmaceutical factory workers and their children as an occupational disease]. Endokrynol Pol. 1971;22(2):149-154.
24. Sansone A, Romanelli F, Sansone M, Lenzi A, Di Luigi L. Gynecomastia and hormones. Endocrine. 2017;55(1):37-44. doi:10.1007/s12020-016-0975-9
25. Kulshreshtha B, Arpita A, Rajesh P, et al. Adolescent gynecomastia is associated with a high incidence of obesity, dysglycemia, and family background of diabetes mellitus. Indian J Endocrinol Metab. 2017;21(1):160. doi:10.4103/2230-8210.196022
26. Yazici M, Sahin M, Bolu E, et al. Evaluation of breast enlargement in young males and factors associated with gynecomastia and pseudogynecomastia. Ir J Med Sci. 2010;179(4):575-583. doi:10.1007/s11845-009-0345-1
27. Dundar B, Dundar N, Erci T, Bober E, Büyükgebiz A. Leptin Levels in Boys with Pubertal Gynecomastia. J Pediatr Endocrinol Metab. 2005;18(10). doi:10.1515/JPEM.2005.18.10.929
28. Dieudonné M-N, Sammari A, Dos Santos E, Leneveu M-C, Giudicelli Y, Pecquery R. Sex steroids and leptin regulate 11β-hydroxysteroid dehydrogenase I and P450 aromatase expressions in human preadipocytes: Sex specificities. J Steroid Biochem Mol Biol. 2006;99(4-5):189-196. doi:10.1016/j.jsbmb.2006.01.007
29. Eren E, Edgunlu T, Korkmaz HA, et al. Genetic variants of estrogen beta and leptin receptors may cause gynecomastia in adolescent. Gene. 2014;541(2):101-106. doi:10.1016/j.gene.2014.03.013
30. Catalano S, Mauro L, Marsico S, et al. Leptin Induces, via ERK1/ERK2 Signal, Functional Activation of Estrogen Receptor α in MCF-7 Cells. J Biol Chem. 2004;279(19):19908-19915. doi:10.1074/jbc.M313191200
31. Fusco R, Galgani M, Procaccini C, et al. Cellular and molecular crosstalk between leptin receptor and estrogen receptor-α in breast cancer: molecular basis for a novel therapeutic setting. Endocr Relat Cancer. 2010;17(2):373-382. doi:10.1677/ERC-09-0340
32. Lorek M, Tobolska-Lorek D, Kalina-Faska B, Januszek-Trzciakowska A, Gawlik A. Clinical and Biochemical Phenotype of Adolescent Males with Gynecomastia. J Clin Res Pediatr Endocrinol. 2019;11(4):388-394. doi:10.4274/jcrpe.galenos.2019.2019.0027
33. Monarca C, Rizzo MI. Gynecomastia. Plast Reconstr Surg. 2013;131(5):863e-865e. doi:10.1097/PRS.0b013e318287a18f
34. Bannayan GA, Hajdu SI. Gynecomastia: Clinicopathologic Study of 351 Cases. Am J Clin Pathol. 1972;57(4):431-437. doi:10.1093/ajcp/57.4.431
35. Li C-C, Fu J-P, Chang S-C, Chen T-M, Chen S-G. Surgical Treatment of Gynecomastia. Ann Plast Surg. 2012;69(5):510-515. doi:10.1097/SAP.0b013e318222834d
36. Sollie M. Management of gynecomastia—changes in psychological aspects after surgery—a systematic review. Gland Surg. 2018;7(S1):S70-S76. doi:10.21037/gs.2018.03.09
37. Ordaz DL, Thompson JK. Gynecomastia and psychological functioning: A review of the literature. Body Image. 2015;15:141-148. doi:10.1016/j.bodyim.2015.08.004
38. Nuzzi LC, Cerrato FE, Erikson CR, et al. Psychosocial impact of adolescent gynecomastia: A prospective case-control study. Plast Reconstr Surg. 2013;131(4):890-896. doi:10.1097/PRS.0b013e3182818ea8
39. Kinsella, C., Jr., Landfair, A., Rottgers, S. A., Cray, J. J., Weidman, C., Deleyiannis, F. W. B.,. . .& Losee JE. The psychological burden of idiopathic adolescent gynecomastia. Plast Reconstr Surg. 2012;129(1-7). doi:10. 1097/prs.0b013e3182361efd
40. March JS, Parker JDA, Sullivan K, Stallings P, Conners CK. The Multidimensional Anxiety Scale for Children (MASC): Factor Structure, Reliability, and Validity. J Am Acad Child Adolesc Psychiatry. 1997;36(4):554-565. doi:10.1097/00004583-199704000-00019
41. Schonfeld WA. Gynecomastia in Adolescence: Effect on Body Image and Personality Adaptation. Psychosom Med. 1962;24(4):379-389. doi:10.1097/00006842-196200700-00008
42. Money J, Lewis V. Homosexual/Heterosexual status in boys at puberty: idiopathic adolescent gynecomastia and congenital virilizing adrenocorticism compared☆. Psychoneuroendocrinology. 1982;7(4):339-346. doi:10.1016/0306-4530(82)90037-3
43. Telegrafo M, Introna T, Coi L, et al. Breast US as primary imaging modality for diagnosing gynecomastia. G di Chir. 2016;37(3):118-122. doi:10.11138/gchir/2016.37.3.118
44. McArthur JW, Toll GD, Russfield AB, Reiss AM, Quinby WC, Baker WH. Sexual precocity attributable to ectopic gonadotropin secretion by hepatoblastoma. Am J Med. 1973;54(3):390-403. doi:10.1016/0002-9343(73)90034-X
45. Fauci, Anthony; Kasper, Dennis; Hauser, Stephen; Longo, Dan; Jameson, Larry; Loscalzo J. Harrison- Manuale Di Medicina. XIX 2017. (: Casa Editrice Ambrosiana, ed.).; 2017.
46. Kanakis GA, Nordkap L, Bang AK, et al. EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology. 2019;7(6):778-793. doi:10.1111/andr.12636
47. Castro-Magana M, Angulo M, Uy J. Male Hypogonadism with Gynecomastia Caused by Late-Onset Deficiency of Testicular 17-Ketosteroid Reductase. N Engl J Med. 1993;328(18):1297-1301. doi:10.1056/NEJM199305063281802
48. Pusl T, Stoemmer P. Gynecomastia: Look Beyond the Obvious. Am J Med. 2017;130(10):e439-e440. doi:10.1016/j.amjmed.2017.04.021
49. Rehman T, Hameed A, Beharry N, Parcq J Du, Bano G. An unusual cause of gynaecomastia in a male. Endocrinol Diabetes Metab Case Reports. 2019;2019. doi:10.1530/EDM-19-0060
50. Lazala C, Saenger P. Pubertal Gynecomastia. J Pediatr Endocrinol Metab. 2002;15(5). doi:10.1515/JPEM.2002.15.5.553
51. Malhotra AK, Amed S, Bucevska M, Bush KL, Arneja JS. Do adolescents with gynecomastia require routine evaluation by endocrinology? Plast Reconstr Surg. 2018;142(1):9E-16E. doi:10.1097/PRS.0000000000004465
52. Diamantopoulos S, Bao Y. Gynecomastia and Premature Thelarche: A Guide for Practitioners. Pediatr Rev. 2007;28(9):e57-e68. doi:10.1542/pir.28-9-e57
53. Nordt CA, DiVasta AD. Gynecomastia in adolescents. Curr Opin Pediatr. 2008;20(4):375-382. doi:10.1097/MOP.0b013e328306a07c
54. Osborne CK. Tamoxifen in the Treatment of Breast Cancer. Wood AJJ, ed. N Engl J Med. 1998;339(22):1609-1618. doi:10.1056/NEJM199811263392207
55. Shahbaz K. Tamoxifen: Pharmacokinetics and Pharmacodynamics. Open Access J Pharm Res. 2017;1(8). doi:10.23880/OAJPR-16000143
56. Lapid O, van Wingerden JJ, Perlemuter L. Tamoxifen therapy for the management of pubertal gynecomastia: a systematic review. J Pediatr Endocrinol Metab. 2013;26(9-10). doi:10.1515/jpem-2013-0052
57. Devoto C E, Madariaga A M, Lioi C X, Mardones N. Terapia médica de la ginecomastia con tamoxifeno. Influencia del volumen y duración de la ginecomastia en el resultado terapéutico. Rev Med Chil. 2007;135(12). doi:10.4067/S0034-98872007001200009
58. Akgül S, Kanbur N, Güçer Ş, Şafak T, Derman O. The histopathological effects of tamoxifen in the treatment of pubertal gynecomastia. J Pediatr Endocrinol Metab. 2012;25(7-8). doi:10.1515/jpem-2012-0105
59. Derman O, Kanbur N, Kılıç I, Kutluk T. Long-term Follow-up of Tamoxifen Treatment in Adolescents with Gynecomastia. J Pediatr Endocrinol Metab. 2008;21(5). doi:10.1515/JPEM.2008.21.5.449
60. Chen Y, Jia X, Chen J, Wang J, Hu M. The Pharmacokinetics of Raloxifene and Its Interaction with Apigenin in Rat. Molecules. 2010;15(11):8478-8487. doi:10.3390/molecules15118478
61. Lawrence SE, Arnold Faught K, Vethamuthu J, Lawson ML. Beneficial effects of raloxifene and tamoxifen in the treatment of pubertal gynecomastia. J Pediatr. 2004;145(1):71-76. doi:10.1016/j.jpeds.2004.03.057
62. Riepe FG, Baus I, Wiest S, Krone N, Sippell WG, Partsch C-J. Treatment of Pubertal Gynecomastia with the Specific Aromatase Inhibitor Anastrozole. Horm Res Paediatr. 2004;62(3):113-118. doi:10.1159/000079882
63. Plourde P V., Reiter EO, Jou H-C, et al. Safety and Efficacy of Anastrozole for the Treatment of Pubertal Gynecomastia: A Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Endocrinol Metab. 2004;89(9):4428-4433. doi:10.1210/jc.2004-0082
64. Beck W, Stubbe P. Endocrinological Studies of the Hypothalamo-Pituitary Gonadal Axis during Danazol Treatment in Pubertal Boys with Marked Gynecomastia. Horm Metab Res. 1982;14(12):653-657. doi:10.1055/s-2007-1019110
65. Ting, AC; Chow, LW; Leung Y. Comparison of tamoxifen with danazol in the management of idiopathic gynecomastia. Am Surg. 2000;66(1):38-40.
66. Plourde P V. Clomiphene in the Treatment of Adolescent Gynecomastia. Am J Dis Child. 1983;137(11):1080. doi:10.1001/archpedi.1983.02140370040013
67. Zachmann M, Eiholzer U, Muritano M, Werder EA, Manella B. Treatment of pubertal gynaecomastia with testolactone. Acta Endocrinol (Copenh). 1986;113(4_Suppl):S218-S226. doi:10.1530/acta.0.112S218
68. Kasielska-Trojan A, Antoszewski B. Gynecomastia Surgery-Impact on Life Quality: A Prospective Case-Control Study. Ann Plast Surg. 2018;80(2):194. doi:10.1097/SAP.0000000000001173
69. Fagerlund A, Lewin R, Rufolo G, Elander A, Santanelli di Pompeo F, Selvaggi G. Gynecomastia: A systematic review. J Plast Surg Hand Surg. 2015;49(6):311-318. doi:10.3109/2000656X.2015.1053398
70. Tu L-C, Tung K-Y, Chen H-C, Huang W-C, Hsiao H-T. Eccentric Mastectomy and Zigzag Periareolar Incision for Gynecomastia. Aesthetic Plast Surg. 2009;33(4):549-554. doi:10.1007/s00266-008-9285-9
71. Rohrich RJ, Ha RY, Kenkel JM, Adams WP. Classification and Management of Gynecomastia: Defining the Role of Ultrasound-Assisted Liposuction. Plast Reconstr Surg. 2003;111(2):909-923. doi:10.1097/01.PRS.0000042146.40379.25
72. Abdelrahman I, Steinvall I, Mossaad B, Sjoberg F, Elmasry M. Evaluation of Glandular Liposculpture as a Single Treatment for Grades I and II Gynaecomastia. Aesthetic Plast Surg. 2018;42(5):1222-1230. doi:10.1007/s00266-018-1118-x
73. Cely AMG, Triana CE, Triana LM. Thorax masculinization in a transsexual patient: Inferior pedicle mastectomy without an inverted T scar. Arch Plast Surg. 2019;46(3):262-266. doi:10.5999/aps.2018.00108
74. Moon J-E, Ko CW, Yang JD, Lee JS. Combined surgical and medical treatment in an adolescent with severe gynecomastia due to excessive estradiol secretion: a case report. BMC Pediatr. 2019;19(1):515. doi:10.1186/s12887-019-1887-7
75. Kim DH, Byun IH, Lee WJ, Rah DK, Kim JY, Lee DW. Surgical Management of Gynecomastia: Subcutaneous Mastectomy and Liposuction. Aesthetic Plast Surg. 2016;40(6):877-884. doi:10.1007/s00266-016-0705-y
76. Yao Y, Yang Y, Liu J, Wang Y, Zhao Y. Vacuum-assisted minimally invasive surgery—An innovative method for the operative treatment of gynecomastia. Surgery. 2019;166(5):934-939. doi:10.1016/j.surg.2019.04.032
77. Tarallo M, Di Taranto G, Fallico N, Ribuffo D. The round-the-clock technique for correction of gynecomastia. Arch Plast Surg. 2019;46(3):221-227. doi:10.5999/aps.2018.00472
78. Qutob O, Elahi B, Garimella V, Ihsan N, Drew P. Minimally invasive excision of gynaecomastia – a novel and effective surgical technique. Ann R Coll Surg Engl. 2010;92(3):198-200. doi:10.1308/003588410X12628812458815
79. Harinatha S. Male Gynecomastia Correction by Superior Dynamic Flap Method: A Consistent and Versatile Technique. World J Plast Surg. 2020;9(1):33-38. doi:10.29252/wjps.9.1.33
80. Arora Y, Mittal RR, Williams EA, Thaller SR. Barriers to the Effective Management of Gynecomastia in Adolescents. J Craniofac Surg. 2019;30(8):2381-2384. doi:10.1097/SCS.0000000000005999
81. Murugesan L, Karidis A. External Quilting: New Technique to Avoid Haematoma in Gynaecomastia Surgery. Aesthetic Plast Surg. 2020;44(1):45-51. doi:10.1007/s00266-019-01537-9
82. Jackson PC, MacInnes EG, Nicholson JK, Brayshaw I, Relton S, Achuthan R. Mastectomy Without Drains Reduces Cost with No Detriment to Patient Outcome. Cureus. 2019;11(7):e5160. doi:10.7759/cureus.5160
83. Keskin M, Sutcu M, Cigsar B, Karacaoglan N. Necessity of Suction Drains in Gynecomastia Surgery. Aesthetic Surg J. 2014;34(4):538-544. doi:10.1177/1090820X14526598
84. Chao JW, Raveendran JA, Maly C, Rogers G, Boyajian M, Oh AK. Closed-Suction Drains After Subcutaneous Mastectomy for Gynecomastia: Do They Reduce Complications? Aesthetic Plast Surg. 2017;41(6):1291-1294. doi:10.1007/s00266-017-0959-z
85. Hansdorfer-Korzon R, Teodorczyk J, Gruszecka A, Lass P. Are compression corsets beneficial for the treatment of breast cancer-related lymphedema? New opportunities in physiotherapy treatment – a preliminary report. Onco Targets Ther. April 2016:2089. doi:10.2147/OTT.S100120
86. Rosen H, Webb ML, DiVasta AD, et al. Adolescent Gynecomastia. Ann Plast Surg. April 2010:1. doi:10.1097/SAP.0b013e3181dba827
87. Bembo SA, Carlson HE. Gynecomastia: its features, and when and how to treat it. Cleve Clin J Med. 2004;71(6):511-517. doi:10.3949/ccjm.71.6.511
88. Al-Allak A, Govindarajulu S, Shere M, Ibrahim N, Sahu AK, Cawthorn SJ. Gynaecomastia: A decade of experience. Surg. 2011;9(5):255-258. doi:10.1016/j.surge.2010.10.004
89. Dialani V, Baum J, Mehta TS. Sonographic Features of Gynecomastia. J Ultrasound Med. 2010;29(4):539-547. doi:10.7863/jum.2010.29.4.539
90. Hines SL, Yasrebi M, Tan WW, Perez EA, DePeri ER. The Role of Mammography in Male Patients With Breast Symptoms. Mayo Clin Proc. 2007;82(3):297-300. doi:10.4065/82.3.297
91. Jones DJ, Holt SD, Surtees P, Davison DJ, Coptcoat MJ. A comparison of danazol and placebo in the treatment of adult idiopathic gynaecomastia: results of a prospective study in 55 patients. Ann R Coll Surg Engl. 1990;72(5):296-298. http://www.ncbi.nlm.nih.gov/pubmed/2221763.
92. Lemaine V, Cayci C, Simmons P, Petty P. Gynecomastia in Adolescent Males. Semin Plast Surg. 2013;27(01):056-061. doi:10.1055/s-0033-1347166
93. Longheu A, Medas F, Corrias F, et al. Surgical management of gynecomastia: Experience of a general surgery center. G di Chir. 2016;37(4):150-154. doi:10.11138/gchir/2016.37.4.150
94. Cordova A, Moschella F. Algorithm for clinical evaluation and surgical treatment of gynaecomastia. J Plast Reconstr Aesthetic Surg. 2008;61(1):41-49. doi:10.1016/j.bjps.2007.09.033
95. Olsson H, Bladstrom A, Alm P. Male gynecomastia and risk for malignant tumours – a cohort study. BMC Cancer. 2002;2(1):26. doi:10.1186/1471-2407-2-26
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Pinelli M, De Maria F, Ceccarelli P, Pedrieri B, Bianchini MA, Iughetti L, De Santis G. Gynecomastia: an uncommon, destabilizing condition of the male adolescent. our therapeutic choice. Acta Biomed [Internet]. 2023 Apr. 24 [cited 2023 May 29];94(2):e2023055. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/14028
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