Approach to gynecomastia and pseudogynecomastia surgical techniques and its outcome: a systematic review

Background: To date, various surgical techniques were developed for gynecomastia and pseudogynecomastia surgery, providing surgeons vast range of options. These variations of techniques, however, may have different efficacy and results depending on the severity of patients' conditions.

Objectives: This review aims to delineate comprehensively the variations of surgical approaches to gynecomastia and pseudogynecomastia in relation to surgical and patients' outcomes.

Methods: Database search (October 28, 2020) from PubMed, Scopus, Science Direct, and Cochrane Library was performed to identify relevant studies using the keywords ("gynecomastia" OR "pseudogynecomastia") AND ("surgery" AND "mastectomy" OR "liposuction") within January 2011-November 2020, published in English. Inclusion criteria were approached according to patients, intervention, comparator, outcomes, and study design (PICOS). Data from the included studies were extracted based on study and subjects' characteristics, type of intervention, and outcome measures.

Results: Out of all relevant studies revealed, 53 studies met inclusion criteria with 5345 subjects included. Most subjects, from 44 studies, were classified as Simon's Grade II (68.49%) with idiopathic cause (94.51%). Most cases were approached using the minimally invasive techniques (37.50%) and were highly satisfied. Among intervention groups, complication rates vary from 12.12-22.30%, with the minimally invasive approach having the lowest rate. Hematoma and bruise were the most reported complications. However, the risk of bias was relatively high due to missing data.

Conclusions: Different surgical approaches for gynecomastia treatment have been described and were consistent with good outcomes. To achieve a low rate of complications, the minimally invasive techniques can be considered, since most patients seem to be satisfied.