PMID- 31216208
OWN - NLM
STAT- MEDLINE
DCOM- 20191202
LR  - 20191202
IS  - 1557-9034 (Electronic)
IS  - 1092-6429 (Linking)
VI  - 29
IP  - 8
DP  - 2019 Aug
TI  - Treatment of Gynecomastia by Endoscopic Subcutaneous Mastectomy in Adolescents.
PG  - 1073-1076
LID - 10.1089/lap.2019.0256 [doi]
AB  - Background: Morbidity of traditional open surgery for the treatment of 
      gynecomastia includes asymmetry, retraction of the nipple, and poor scarring. 
      Other approaches were described to improve the results. Endoscopic subcutaneous 
      mastectomy (ESCM) was reported in adult series, including a few adolescents. This 
      technique was considered as safe with good aesthetic results. The aim of this 
      study was to evaluate the results of ESCM in an adolescent series. Patient and 
      Methods: We treated 19 adolescents with Simon's grade IIB and III gynecomastia 
      between June 2014 and July 2018. They could choose open surgery through the 
      nipple or endoscopic surgery by axillary approach. To perform ESCM, three trocars 
      were placed on the midaxillary line to dissect the gland. The resection was 
      performed leaving 1 cm thickness of gland behind the nipple. The gland was 
      extracted after morcellation through the 10 mm trocar. A drainage tube was placed 
      in the cavity. The patients wore a thoracic belt smoothly compressing the 
      operative areas for 15 days. The result was considered as good when there was no 
      remaining gland, good symmetry, and no nipple retraction or nipple lateral 
      displacement. Results: During the study period, 12 adolescents were treated by 
      ESCM and 7 preferred open surgery. Among the 12 ESCM patients, 7 had bilateral 
      and 5 unilateral gynecomastia. A subcutaneous injection of serum was done in the 
      last 6 patients to facilitate the creation of the work space. A 2- or 3-mm 
      second-degree burn occurred in 4 cases, 2 on the nipple and 2 just above the 
      nipple, with a 2 mm remaining scar above the nipple in 1 case. The postoperative 
      course was uneventful in 11 adolescents. One subcutaneous seroma expanded at 15 
      days postoperative and resolved after 3 weeks of prolonged compression by 
      thoracic belt. The adolescents had 11 good results and 1 persistent asymmetry; 2 
      other asymmetries had a spontaneous improvement after 1 or 2 years. Conclusion: 
      ESCM is feasible and safe for the treatment of gynecomastia in adolescents. This 
      technique is challenging but permits to reach good aesthetic results and avoids 
      scars on the anterior wall of the thorax.
FAU - Varlet, Francois
AU  - Varlet F
AD  - 1Department of Pediatric Surgery, University Hospital, Saint-Etienne, France.
FAU - Raia-Barjat, Tiphaine
AU  - Raia-Barjat T
AD  - 2Department of Gynecology-Obstetrics, University Hospital, Saint-Etienne, France.
FAU - Bustangi, Nasser
AU  - Bustangi N
AD  - 1Department of Pediatric Surgery, University Hospital, Saint-Etienne, France.
FAU - Vermersch, Sophie
AU  - Vermersch S
AD  - 1Department of Pediatric Surgery, University Hospital, Saint-Etienne, France.
FAU - Scalabre, Aurelien
AU  - Scalabre A
AD  - 1Department of Pediatric Surgery, University Hospital, Saint-Etienne, France.
LA  - eng
PT  - Journal Article
DEP - 20190619
PL  - United States
TA  - J Laparoendosc Adv Surg Tech A
JT  - Journal of laparoendoscopic & advanced surgical techniques. Part A
JID - 9706293
SB  - IM
MH  - Adolescent
MH  - Cicatrix
MH  - Drainage
MH  - Endoscopy/*methods
MH  - Esthetics
MH  - Gynecomastia/*surgery
MH  - Humans
MH  - Male
MH  - Mastectomy, Subcutaneous/*methods
MH  - Minimally Invasive Surgical Procedures/*methods
MH  - Nipples/*surgery
MH  - Postoperative Period
MH  - Retrospective Studies
MH  - Seroma
MH  - Thorax
MH  - Treatment Outcome
OTO - NOTNLM
OT  - adolescent
OT  - endosurgery
OT  - gynecomastia
OT  - mastectomy
EDAT- 2019/06/20 06:00
MHDA- 2019/12/04 06:00
CRDT- 2019/06/20 06:00
PHST- 2019/06/20 06:00 [pubmed]
PHST- 2019/12/04 06:00 [medline]
PHST- 2019/06/20 06:00 [entrez]
AID - 10.1089/lap.2019.0256 [doi]
PST - ppublish
SO  - J Laparoendosc Adv Surg Tech A. 2019 Aug;29(8):1073-1076. doi: 
      10.1089/lap.2019.0256. Epub 2019 Jun 19.