Prezioso Domenico, Piccirillo Giuseppe, Galasso Raffaele, Altieri Vincenzo, Mirone Vincenzo, Lotti Tullio
Department of Urology, University of Naples Federico II, Italy.
Tumori. 2004 Jul-Aug;90(4):410-5. doi: 10.1177/030089160409000409.
Gynecomastia is an abnormal increase in the volume of the male breast that is generally considered to be due to an increased estrogen/androgen ratio. Pathological causes of gynecomastia include organic diseases and therapy, such as the administration of estrogens and antiandrogens, which alter the ratio of circulating hormones. Hormone therapy for prostate cancer is generally well tolerated but often accompanied by the occurrence of gynecomastia and breast pain or tenderness. The increased use of antiandrogens as monotherapy is leading to an increase in the number of patients affected by gynecomastia. Treatments are available to alleviate or prevent the development of gynecomastia, including medical treatment with antiestrogens and aromatase inhibitors. Alternatively, mastectomy with excision of the gland, liposuction or an association of the two techniques have proved to be effective. Radiation therapy may provide effective relief from the breast pain associated with gynecomastia. In this paper we show the good results of mastectomy performed with a lower semicircular periareolar incision in men suffering from gynecomastia due to antiandrogen therapy for inoperable prostate cancer. In addition, we present a review of the various techniques used for the treatment of gynecomastia.
During the period from September 1998 to May 2001, 10 patients receiving hormone treatment for metastatic or inoperable prostatic cancer were selected for the study if they had breast pain and bilateral gynecomastia. Five of these patients had been offered prophylactic radiotherapy before treatment but refused, while the remaining five patients had refused radiotherapy after hormone treatment. These patients were therefore given the option of surgical treatment. Before surgery all patients underwent clinical and ultrasound examination of the breast. All surgical samples were examined histopathologically. During follow-up clinical examinations were carried out one week, one month, six months, one year and two years after surgery.
The results were satisfactory in all patients especially from an aesthetic point of view. Moreover, breast pain disappeared about one week after surgery. After a follow-up of 6-36 months (average, 22.8 months) no recurrences were observed. Only a few immediate postoperative complications were recorded (hematoma in one case and seroma in another). Histological examination of the excised glands showed fibrosclerotic tissue and a small amount of fat.
Surgical liposuction can be considered an effective treatment for gynecomastia, in particular in the very early stages because the breast becomes irreversibly fibrous as the disease progresses. This surgical technique is simple and effective and is therefore to be considered favorable, especially because of the very short hospitalization and the absence of complications.
男性乳腺增生是男性乳房体积异常增大，通常认为是由于雌激素/雄激素比例升高所致。男性乳腺增生的病理原因包括器质性疾病和治疗，如使用雌激素和抗雄激素药物，这会改变循环激素的比例。前列腺癌的激素治疗一般耐受性良好，但常伴有男性乳腺增生以及乳房疼痛或压痛的发生。抗雄激素作为单一疗法的使用增加，导致受男性乳腺增生影响的患者数量增多。有多种治疗方法可减轻或预防男性乳腺增生的发展，包括使用抗雌激素和芳香化酶抑制剂进行药物治疗。另外，切除腺体的乳房切除术、抽脂术或两种技术联合使用已被证明是有效的。放射治疗可为与男性乳腺增生相关的乳房疼痛提供有效缓解。在本文中，我们展示了采用乳晕下半圆形切口对因抗雄激素治疗不可切除前列腺癌而患有男性乳腺增生的男性患者进行乳房切除术的良好效果。此外，我们还对用于治疗男性乳腺增生的各种技术进行了综述。
在1998年9月至2001年5月期间，选择10名接受转移性或不可切除前列腺癌激素治疗且伴有乳房疼痛和双侧男性乳腺增生的患者进行研究。其中5名患者在治疗前曾被提供预防性放疗但拒绝，其余5名患者在激素治疗后拒绝放疗。因此，这些患者被给予手术治疗的选择。手术前，所有患者均接受了乳房的临床和超声检查。所有手术标本均进行了组织病理学检查。随访期间，在术后1周、1个月、6个月、1年和2年进行临床检查。
所有患者的结果均令人满意，尤其是从美学角度来看。此外，乳房疼痛在术后约1周消失。经过6 - 36个月（平均22.8个月）的随访，未观察到复发。仅记录了少数术后即刻并发症（1例血肿和1例血清肿）。切除腺体的组织学检查显示为纤维硬化组织和少量脂肪。
手术抽脂可被视为治疗男性乳腺增生的有效方法，特别是在疾病早期，因为随着病情进展乳房会不可逆地纤维化。这种手术技术简单有效，因此应被视为有利的方法，尤其是因为住院时间非常短且无并发症。
