Recently, three patients with gynecomastia were admitted to the general surgery department, one with bilateral breast development and the other two with unilateral breast development with breast pain. The patient was admitted to the hospital to improve the preoperative examination, using small incisions under the outer edge of the breast, suspension and pulling techniques, the whole process of electric knife free, the operation was completed successfully, and none of the postoperative cases of nipple areola ischemic necrosis and subcutaneous fluid, the postoperative breast appearance is satisfactory, the patient’s confidence regained, and he was discharged after a week of recovery. Gynecomastia, also known as gynecomastia, gynecomastia or gynecomastia, refers to the abnormal development of male breast tissue, which is a more common benign disease among male breast diseases, accounting for about 60-80% of male breast diseases, and pathologically, it is only ductal hyperplasia without alveolar hyperplasia, and the onset can be seen at almost any age, but mostly in middle and old age and adolescence. The pathophysiological process of gynecomastia is mainly due to an imbalance between free estrogens and androgens in the breast tissue. A variety of mechanisms can lead to this imbalance. (1) Physiological: Most commonly seen in adolescence and older adults. In adolescence, anterior pituitary gonadotropins stimulate the production of testosterone and estrogen, which in some cases leads to a decrease in the ratio of estrogen to androgen in the serum, producing a transient increase in breast development; in elderly patients, it is due to an increase in the activity of aromatase in the body, which results in an excessive conversion of androgens to estrogen. ②Drug-related: such as the application of estrogen preparations for prostate cancer, cimetidine, ambrisentin, chlorpromazine, reserpine, remifentan, highly effective antiviral drugs used in the treatment of HIV infection, certain chemotherapeutic drugs, especially alkylating agents and certain drugs: marijuana, heroin, etc. (iii) Idiopathic gynecomastia: the etiology is unknown, and various hormone measurements in the body are normal. ④Primary hypogonadism. Such as: primary testicular dysplasia, testicular trauma, cryptorchidism, viral infection (mumps), testicular tuberculosis, etc. resulting in reduced androgen secretion. ⑤ Secondary hypogonadism. Such as: pituitary or pars plana tumor, hypothyroidism, etc. (6) Hyperthyroidism: The conversion of androgens into estrogens increases, and the binding of hormones to receptors is enhanced. (7) Cirrhosis: caused by low liver function and decreased ability to inactivate estrogen. (8) Tumor diseases: testicular mesenchymal cell and supporting cell tumors, seminoma, hepatocellular carcinoma (when the aromatase activity of the tumor itself is increased), adrenal cortical tumors, etc.; others can also be caused by ectopic HCG (chorionic gonadotropin) secretion and indirect production of estradiol. For example, bronchial lung cancer, malignant tumors of the stomach and pancreas, etc. 9. Certain congenital anomalies: e.g., male female mammary-hypogonadotropic syndrome, Klinefelter syndrome (XXXXY syndrome), etc. are often associated with chromosomal aberrations and family history. In this case, the receptors are not sensitive to androgens. The main clinical manifestation of gynecomastia is that the breast resembles the adolescent female breast, and a firm lump can be palpated under the nipple areola, some patients have breast swelling or tenderness, and there is usually no nipple overflow. Mammograms show elliptical, patchy, or nodular hyperdense shadows without calcified shadows or skin thickening shadows, and no nipple invagination. The diagnosis of this disease should be made by first looking for possible causes. Ask about the history of medication, family history, liver disease, etc., and make the diagnosis through symptoms and physical examination. If necessary, hormone levels such as HCG, luteinizing hormone, testosterone and estradiol should be tested or histological examination should be performed. It should also be differentiated from male breast cancer, pseudogynecomas, fibroadenomas and lipomas. Gynecomastia is treated differently depending on the cause. Physiological gynecomastia mostly occurs during puberty, and usually returns to normal in about a year or at the age of 20, so it can be observed temporarily and there is no need to rush to surgery. If it is caused by drugs, stop using all drugs that cause breast development. Tumor-induced patients should be treated actively for the primary disease. Gynecomastia patients with ER, PR
Mostly positive, endocrine therapy (triamcinolone acetonide) can be tried for 3 months, but attention should be paid to drug side effects. For patients with overly large breasts that cannot be retracted in adulthood and affect their body shape; no etiology can be found for the onset of the disease in adulthood,
For those who have developed in adolescence, who are under great psychological pressure and who urgently require cosmetic surgery, and for those who have had the disease for more than one year, there is fibrous tissue hyperplasia, which is difficult to recover with medication,
Surgery can be considered. Depending on the shape of the breast, either subareolar mastectomy or total mastectomy with preservation of the nipple and areola is possible. In the above three cases, all three patients underwent total mastectomy with preservation of the nipple areola, and the postoperative results were satisfactory.