| Background Gynecomastia is also known as male breast hypertrophy or male hyperplasia of mammary glands which refers to abnormal developments or hyperplasia in the male breast duct tissue or adipose tissue.It's usually due to elevated estrogen,decreased androgen,imbalance between estrogen and androgen,or breast tissuesensitivity for estrogen.Performances in male unilateral or bilateral breast area includepalpable discoid or diffuse nodules,as the most frequent symptom,breast pain,and occasional manifestations,nipple retraction and discharge which can both occur in different periods and age stages.With the improvement of the overall living standard and public health awareness,changes inlife style,refinement and diversity of the medical examination,more and more male breast development patients were diagnosed and treated in recent years.The treatment of disease is clinically divided into medical treatment and surgical treatment.In terms of surgical treatment,frequently-used methodsinclude now sharp resection surgery,minimally invasive surgery,mastoscopic surgery,liposuction or lipid fusion and combinations of several improved surgery,which have pros and cons.With the increasing demand for aesthetic needs,majority of patientsbegin to pursueoperations whose trauma is small,quick recovery,beauty.Objective This article contrastssystematically the current surgical methods for the treatment of Gynecomastia,makes a detailed analysis of these clinical effects and aims to guide the selection of clinical operation.Methods The study is a retrospective study that 164 cases of Gynecomastia were collected for the researchfrom February 2014 to July 2016 in the Zhengzhou University People's Hospital.The subjects were divided into A,B,C and D groups according to the different surgical methods.A Group was treated with ring small incision around mammary areola and complete removal of glands by electrotome in the whole course of operation;Bgroupuse the minimally invasive technology toremove glands under the guidance of color Doppler ultrasound;C groupuse negative pressure liposuction to suck operative regional fat and postuse minimally invasive technology to remove glands under the guidance of color Doppler ultrasound;D group first use negative pressure liposuction method to remove the surgical area of fat,and then usemastoscopic to resect glands.The operative time,intraoperative blood loss,incision scar,length of patient stay,postoperative complications(subcutaneous effusion,subcutaneous hemorrhage and incision infection in 2 weeks),total effective rate(2 weeks after surgery)and satisfaction(bilateral symmetry satisfaction,surgical skin and nipple sensory satisfaction and overall patient self-satisfaction after 6 months)were analyzed.Results 1.Within the selected range,the operation time(unilateral)was 47.9 ± 9.3min in group A,51.5 ± 7.6min in group B,34.5 ± 5.7min in group C and 49.3 ± 14.6min in group D.The difference was statistically significant in studiedby analysis of variance(F = 2.465,P<0.001).After the adjusting inspection level of Bonferroni method,C group was better than A group,B group and D group(P<0.008).The intraoperative blood loss was 31.2 ± 8.1ml in group A,33.6 ± 9.9ml in group B,30.4 ± 9.1ml in group C and 20.1 ± 6.4ml in group D.There were significant differences between the four groups(F = 6.423,P = 0.031).After the adjusting inspection level of Bonferroni method,D group was better than A group,B group and C group(P <0.008).The incision scar was 2.8 ± 0.8cm in group A,0.5 ± 0.2cm in group B,0.5 ± 0.1cm in group C and 1.2 ± 0.3cm in group D.There was significant difference in the four groups(F = 13.421,P <0.001).Afterthe adjusting inspection level of Bonferroni method,B group,C group and D group was better than A group(P <0.008).The postoperative hospital stay was 4.6 ± 1.4 d in group A,3.1 ± 1.3d in group B,2.8 ± 0.8d in group C,2.9± 1.0d in group D.There was significant difference in the four groups(F = 7.696,P = 0.029)(P <0.008).After the adjusting inspection level of Bonferroni method,group B,group C,group D were better than group A(P<0.008).2.postoperative complications :There was no significant difference in the incidence of subcutaneous effusion(P> 0.05).The incidence of subcutaneous hemorrhage was 4.3% in group A,12.96% in group B,2.5% in group C and 0 in group D.The difference was statistically significant by analysis of variance(P = 0.004).After the adjusting inspection level of Bonferroni method,D group was superior to group A,and group C was superior to group B(P<0.008).The incidence of incision infection was 4.3% in group A and 0 in group B,C and D.The difference was statistically significant(P<0.001)by chi-square test.After adjusting the test level Bonferroni method,group B and group C,group D was superior to group A(P<0.008).3.total effective rate on 2 weeks after surgery: The curative effect of the four groups was 100% after the adjusting inspection level of Bonferroni method.So the difference was not statistically significant.4.Follow-up 6 months satisfaction: the bilateral symmetry satisfaction score was 6.1 ± 1.3 points in A group,7.2 ± 1.2 points in B group,was 8.2 ± 0.8 points in C group,was 8.1 ± 0.7 points in D group.The difference was statistically significant(F = 4.556,P = 0.026).The Bonferroni method was used to comparebetween two groups after the adjustment of the test level.The group C,D was superior to thegroup B and group Bwas superior to the group A(P <0.008).The skin and nipple sensory satisfaction score was 6.5 ± 1.2 in group A,7.5 ± 1.2 in group B,7.6 ± 1.3 in group C,7.5 ± 1.2 in group D,(F = 5.001,P = 0.041).The difference was statistically significant by analysis of variance(F = 5.001,P = 0.041));The Bonferroni method was used to comparebetween two groups after the adjustment of the test level.The group B,C,D was superior to the group A(P<0.008).The overall self-satisfaction score was 6.5 ± 1.3 points in group A,7.1 ± 1.3 in group B,8.4 ± 1.2 in group C,8.1 ± 1.2 in group D.The difference was statistically significant by analysis of variance(F = 3.968,P = 0.018).The Bonferroni method was used to comparebetween two groups after the adjustment of the test level.The group C was superiorthangroup D,group D was better thangroup B,group B was better than group A(P<0.008).Conclusion 1.Simple glandectomy,minimally invasive resection,a combination of liposuction and minimally invasive resection,a combination of liposuction and endoscopic techniques all havegood efficiencies and are effective surgical means in the treatment of male breast;2.The combination liposuction with minimally invasive techniques and the combination liposuction with endoscopic technique,both have shorter operation time,hidden incision,better postoperative appearance,fewer complications,and higher overall satisfaction.As a whole,The above two methods have good clinical application values and are worthy of promotion in the treatment of Gynecomastia. |
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