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Amaç: Jinekomasti tedavisinde cerrahi yaklaşımlar, özellikle cilt ve fibroglandüler doku fazlalığında liposuctionın yetersizliği ile medikal tedavinin yan etki oluşturma endişesi nedeniyle hâlâ güncel kalmaya devam etmektedir. Bu çalışmada ameliyat ettiğimiz olguların memnuniyet düzeyleriyle birlikte sunulması ve jinekomasti tedavisi için farklı cerrahi seçeneklere dikkat çekilmesi amaçlanmıştır. Yöntem: İki çocuk cerrahisi merkezinde, 2001-2019 yılları arasında Simon evrelendirmesine göre üç farklı teknikle ameliyat edilen 60 olgunun dosyaları geriye dönük olarak incelendi. Simon-I ve IIA olgularının ameliyat kararı en az üç yıllık takibin sonunda verilirken Simon-IIB ve III için bu kadar süre beklenilmedi. Tüm olguların ameliyat sonucunu nasıl değerlendirdiklerine dair 5’li Likert skalasına göre memnuniyet düzeyleri belirlendi. Bulgular: Ortalama yaş 15.46 yıl (12-21) ve izlem süresi 6.51 yıl (2-18) olan olguların %40’ı (n=24) tek, %60’ı (n=36) çift taraflıydı. Endokrinoloji ve psikiyatri bölümleriyle birlikte değerlendirilen olguların onunda ek anomali saptandı. Altısında parsiyel androjen duyarsızlık sendromu, bunların üçünde hipospadias ile birlikte uzun dönem testosteron kullanım öyküsü vardı. Simon-I olan 10 ve Simon-IIA olan 26 olguya İnfra-areolar Semisürküler Subkutan Mastektomi (İSSM), Simon-IIB olan 20 olguya İnfra-areolar Hilal Cilt Ada Eksizyonu ile Mastektomi (İHCAEM), Simon-III olan 4 olguya Vertikal Redüksiyon Mamoplasti (VRM) teknikleri uygulandı. Tüm olgularda hemovak dren kullanıldı. Erken dönemde iki olguda seroma, bir olguda hematom gelişti. Geç dönemde bir olguda meme başı çökmesi, bir olguda minimal cilt deformitesi saptandı. Tüm olgularımızda genel memnuniyet oranı %98.3 olarak belirlendi. Sonuç: Adolesan için ciddi psikososyal bir sorun olan jinekomastinin tedavisinde esas olan tüm olguların multidisipliner olarak ele alınması ve en iyi sonuca ulaşmak için tüm farklı tekniklerin bilinmesidir.
Purpose: The surgical approaches in the treatment of gynecomastia, especially in the skin and fibroglandular tissue excess, continue to remain up-to-date due to the lack of liposuction and the fear of creating side effects of medical treatment. The aim of this study is to present the facts we have operated along with the levels of satisfaction and to draw attention to different surgical options for the treatment of gynecomastia. Method: In the two children's surgical center, the files of 60 phenomena operated by three different techniques according to Simon's evolution between 2001 and 2019 were reviewed backward. The surgical decision of the Simon-I and IIA cases is made at the end of at least three years of follow-up, while Simon-IIB and III are not expected to take so much time. According to the 5 Likert scale of how all incidents assessed the outcome of the surgery, satisfaction levels were determined. Results: The average age of 15.46 years (12-21) and the observation period of 6.51 years (2-18) were 40 percent (n=24) single, 60 percent (n=36) double-sided. Additional anomaly was found in the facts evaluated along with the endocrinology and psychiatric departments. In the sixth part of the androgenic insensitivity syndrome, the third of them had a long-term history of testosterone use along with hipospadias. In Simon-I, 10 and Simon-IIA, 26 incidents of the Infrared Semisürkular Subcutaneous Mastectomy (ISM), Simon-IIB, 20 incidents of the Infrared Infrared Skin Island Excision and Mastectomy (IHCAEM), Simon-III, 4 incidents of the Vertical Reduction Mamoplasty (VRM) techniques were applied. In all cases, heemovak dren was used. In the early two periods, seroma developed, and hematoma developed in one. In the late period, the fall of the breast in a case, a minimal skin deformity in a case was detected. In all cases, the overall satisfaction rate was 98.3%. Results: All the facts that are based on the treatment of gynecomastia, a serious psychosocial problem for Adolesan, are multidisciplinary and all the different techniques are known to
Objective: Surgical approaches to the treatment of gynecomastia are still popular due to concerns regarding the side effects of medical therapy, particularly with the failure of liposuction in the presence of excessive skin and fibroglandular tissue. We present here the results of a satisfaction questionnaire administered to patients who underwent surgery for the treatment of gynecomastia, drawing attention to the different surgical options. Method: The medical charts of 60 cases who underwent surgery in two pediatric suregery centers using three different techniques, selected based on the Simon’s-classification, between 2001-2019 were reviewed retrospectively. The surgical approach was selected based on at least a 3-year follow-up period in cases with Grade-I and IIA, while there was no waiting period for patients with Grade-IIB and III. Satisfaction levels were determined according to the 5-point Likert-scale regarding how all patients evaluated the surgical outcome. Results: The mean age of the respondents was 15.46-years (12–21), the mean duration of follow-up was 6.51-years (2–18), and 40% (n=24) of the patients had unilateral and 60% (n=36) had bilateral gynecomastia. The cases were examined individually in consultation with the departments of endocrinology and psychiatry. Of the total, 6-patients were found to have partial androgen insensitivity syndrome three with hypospadias and a history of long-term testosterone use. 10-patients with Grade-I and 26-patients with Grade-IIA underwent an infraareolar-semicircular-subcutaneous-mastectomy (ISSM); 20-patients with Grade-IIB underwent an infraareolar-crescent-skin-sland excision and mastectomy (ICSIEM); and 4-patients with Grade-III underwent a vertical-reduction-mammoplasty (VRM). A hemovac drain was inserted in all patients. Minor complications occurred in 3-patients in the early term and in 1-patient in the long term. The overall satisfaction rate of the patients was 98.3%. Conclusion: The basic principle behind the treatment for gynecomastia, which constitutes a significant psychosocial health problem during adolescence, is the multidisciplinary management of cases with knowledge of all the available techniques so as to achieve the best outcome.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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