الفهرس 
Relevant AnatomyOnly 14 pages are availabe for public view
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Abstract
Gynecomastia is a benign enlargement of the male breast. There are three distinct peaks in the age distribution of gynecomastia:- neonatal (60 to 90%), pubertal (38%) and adult onset (35 to 65%).
The underlying etiology usually involves the relative or absolute excess in circulating estrogen, a deficiency of circulating androgen or a defect in androgen receptors. It is either due to primary (physiological), or secondary (pathological) cause. The physiological gynecomastia can present as neonatal, prepubertal, pubertal, adult onset gynecomastia. While the pathological type might be due to: neoplasm, endocrinal disease, metabolic disorder, drug induced and familial syndromes.
Many surgeons classified gynecomastia aiming to correlate the clinical presentation of gynecomastia with the surgical treatment.
Gynecomastia was classified according to size of the breast into; Group (1) where there is minor but visible breast enlargement without skin redundancy. Group (2A) with moderate breast enlargement without skin redundancy. Group (2B) with moderate breast enlargement with minor skin redundancy. Group (3) with gross breast enlargement with skin redundancy that simulates a pendulous female breast. Patients in groups 1 and 2 require no skin excision, but the breast development associated with group 3 is so marked that excess skin must be removed.
A new system of classification was proposed based on glandular versus fibrous hypertrophy and the degree of breast ptosis (skin excess) in relation to the treatment with ultrasound-assisted liposuction.
The histological appearance of gynecomastia can be classified in to: fibrous, florid and intermediate type, and beside the usual cytological features, the unusual one must be carefully assessed as it might misinterpreted as a feature of malignancy and cause a diagnostic bias.
The diagnosis of a patient with gynecomastia needs clinical history taking, physical examination, and investigations. The history should include: onset, duration, history of drug intake, history of systemic diseases. General examination of the abdomen, thyroid gland and testicular examination should be done. Local examination of breasts, nipple-areola complex, skin redundancy and axillary lymph nodes. Investigations should be limited and individualized to address abnormalities identified in the history and physical examination. Certain defined finding should prompt further evaluation, these include: FNAB, mammography, breast ultrasound and hormonal assay.
The distressing aspect to the patient is the alternation in body image. School age children particularly face considerable embarrassment regarding their gynecoid breast. Therefore, the goal in treatment is to restore the normal male breast configuration, with a perfect aesthetic result and to exclude malignant changes via the histological examination.
The reason for plastic surgical treatment of gynecomastia is mainly psychological and involves body image, which is defined as the subjective perception of the body as it is seen through the minds eye
There are different modalities for treatment of gynecomastia. Reassurance in primary (physiological) gynecomastia and treating the cause in secondary type, leads to spontaneous regression, however if the duration of the disease is lengthy (more than 12 months) it will leave a residual mass. Medical treatment has limited success. Irradiation is a good choice for those patients with cancer prostate.
Surgical treatment include: open excision techniques (with or without skin reduction), liposuction (suction assisted lipoplasty ,ultrasound assisted liposuction or laser liposuction) and endoscopic intervention. Open excision techniques and suction assisted liposuction can be combined to get the best results.
The ultrasound assisted liposuction emerged is a safe and effective method for treating gynecomastia. It is particularly effective in the removal of dense fibrous male breast tissue offering advantages of minimal external scaring. It is effective in the treatment of most grades of gynecomastia and excision techniques are reserved for sever gynecomastia with significant excessive skin after attempted ultrasound assisted liposuction.
Recently combining power assisted liposuction and the pull-through technique has proven to be a versatile approach for the treatment of gynecomastia and consistently produces a naturally contoured male breast while resulting in a single inconspicuous scar.
Laser liposuction is becoming more popular every day. More people are opting for laser liposuction because it is a quick fix to the fat on their body. When taking care of the body, laser liposuction can keep the fat and cellulite off for life. The difference between Traditional Liposuction and Laser Liposuction
1-Laser Liposuction is more effective at getting the fat out and less down time after having the procedure.
2-Laser liposuction also requires minimal downtime.