Bodybuilder Gynecomastia: Etiology, Characteristics, and Management

El Wakeel, Helmy; Abou Arab, Mohamed H.; Kholosy, Hassan M.

doi:10.21608/ejprs.2021.183853

Bodybuilder Gynecomastia: Etiology, Characteristics, and Management

Document Type : Original Article

Authors

The Department of Plastic Surgery, Faculty of Medicine, Alexandria University, Egypt

10.21608/ejprs.2021.183853

Abstract

Background: Bodybuilder gynecomastia represent a special
entity, being secondary to use/abuse of anabolic steroids
leading to glandular enlargement as the sole or the main
underlying pathology with an occasional fatty element. Typical
management entails complete gland excision through the least
visible scar, (typically periareolar) with preservation of pectoral
muscle and fascia integrity. Adjuvant small volume liposuction
is needed in some cases with a fatty element.
Patients and Methods: The study enrolled a series of 13
bodybuilders with gynecomastia and a history of anabolic
steroids use/abuse. All cases presented with glandular tissue
enlargement, with fatty element noted in 4 cases. Operations
were done under general anesthesia with tumescent fluid
infiltration. Through an inferior periareolar incision, almost
the whole enlarged gland was excised, with adjuvant liposuction
as indicated. Meticulous hemostasis and preservation of
pectoral fascia integrity aimed to minimize excessive scaring
beneath a thin overlying areolar skin flap and possible subsequent
adhesions and contour irregularities.
Results: All cases achieved final satisfactory results with
high patients satisfaction. Early complications included minor
hematoma in one case. Probably this was the cause of later
dynamic depression seen with pectoral muscle contraction
noted at 6 months follow-up and resolved spontaneously
during the next year.
Conclusion: Bodybuilder gynecomastia management
entails almost complete glandular tissue excision with limited
liposuction in some cases. Meticulous technique including
proper hemostasis is important to avoid even the minor contour
irregularities and other complications in such demanding
cases seeking perfect shape.

Main Subjects

Aesthetics

References

REFERENCES
1- Rahmani S., Turton P., Shaaban A. and Dall B.: Overview
of gynecomastia in the modern era and the Leeds Gynaecomastia
Investigation algorithm. Breast J., 17: 246-255,
2011.
2- Schonfeld W.A.: Gynecomastia in adolescence: Effect on
body image and personality adaptation. Psychosom. Med.,
24: 379-389, 1962.
3- Fagerlund A., Lewin R., Rufolo G., et al.: Gynecomastia:
A systematic review. J. Plast. Surg. Hand Surg., 49: 311-
318, 2015.
4- Ratnam B.V.: A new classification and treatment protocol
for gynecomastia. Aesthet. Surg. J., 29: 26-31, 2009.
5- Lewis C.M.: Lipoplasty: treatment for gynaecomastia.
Aesthetic Plast. Surg., 9: 287-292, 1985.
6- Morselli P.G. and Morellini A.: Breast reshaping in gynecomastia
by the ''pull-through technique'': Considerations
after 15 years. Eur. J. Plast. Surg., 35 (5): 365-371, 2012.
7- Lista F. and Ahmad J.: Power-assisted liposuction and the
pull through technique for the treatment of gynecomastia.
Plast. Reconst. Surg., 121 (3): 740-7, 2008.
8- Hammond D.C., Arnold J.F., Simon A.M. et al.: Combined
use of ultrasonic liposuction with the pull-through technique
for the treatment of gynecomastia. Plast. Reconst.
Surg., 112 (3): 891-5, 2003.
9- Kim D.H., Byun I.H., Lee W.J., et al.: Surgical management
of gynecomastia: subcutaneous mastectomy and liposuction.
Aesthet. Plast. Surg., 40: 877-884, 2016.
10- Bowman J.D., Kim H. and Bustamante J.J.: Drug-induced
gynecomastia. Pharmacotherapy, 32: 1123-1140, 2012.
11- Pope H.G. and Katz D.L.: Psychiatric and medical effects
of anabolic-androgenic steroid use: A controlled study of
160 athletes. Arch. Gen. Psychiatry, 51: 375-382, 1994.
12- Blau M. and Hazani R.: Correction of Gynecomastia in
Body Builders and Patients with Good Physique Plast.
Reconstr. Surg., 135: 1-9, 2015.
13- Aiache A.E.: Surgical treatment of gynecomastia in the
bodybuilder. Plast. Reconstr. Surg., 83: 61-66, 1989.
14- Reyes R.J., Zicchi S., Hamed H., et al.: Surgical correction
of gynaecomastia in bodybuilders. Br. J. Clin. Pract., 49:
177-179, 1995.
15- Babigian A. and Silverman R.T.: Management of gynecomastia
due to use of anabolic steroids in bodybuilders.
Plast. Reconstr. Surg.,107: 240-242, 2001.
16- Simon B.E., Hoffman S. and Kahn S.: Classification, and
surgical correction of gynecomastia. Plast. Reconstr.
Surg., 51: 48-52, 1973.