[Puberal gynecomastia: a comparison between the inferior periareolar approach and the concentric circle technique].

Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica

PubMedID: 24482905

Estors Sastre B, Bragagnini Rodríguez P, Silva Bueno M, Galeano Ricaño N, Fernández Atuan R, González Esgueda A, Elías Pollina J. [Puberal gynecomastia: a comparison between the inferior periareolar approach and the concentric circle technique]. Cir Pediatr. 2013;26(3):129-34.
BACKGROUND/PURPOSE
The main reason to indicate the surgical treatment in pubertal gynecomastia is the psychological effect on the adolescent. The aim of this paper is to describe our experience in the surgical treatment of this condition, comparing the results obtained depending on the type of approach used.

MATERIAL AND METHODS
In our department, the approach for the subtotal mastectomy depends mainly on the gynecomastia grade. We use an inferior periareolar incision in grades I and II, and a concentric circle technique in grade III of Simon's classification. A retrospective review was conducted to identify all adolescent patients that underwent to gynecomastia surgical treatment between 2007 and 2012. We compared the results obtained in each incision group by parametric statistical tests,

RESULTS
A total of 29 mastectomies were performed in 15 patients. The mean age of surgery was 13.75 +/- 1.06 years ([11-15] years). The presentation in all cases consisted in a progressive increase in size of the mammary gland, without associated symptoms. In half of patients there was a history of obesity or overweight. We performed the concentric circle technique in 5 patients (CCT-group) and inferior periareolar incision in 10 (IPI-group). There was a higher incidence of pathologic scarring in the CCT-group, and this difference was statistically significant (p = 0.007). No recurrences were observed after a mean follow-up of 15.86 +/- 19.47 months ([3-60) months).

CONCLUSIONS
Long term results were satisfactory in both groups. Despite of the higher incidence of hypertrophic and keloid scars observed in concentric circle technique, it remains aesthetically advantageous in cases of gynecomastia with extra skin.