Surgical Correction Of Adolescent Gynecomastia: Complications And Their Impact On Health-related Quality Of Life
Catherine T. McNamara, BS, Laura C. Nuzzi, BA, Joseph M. Firriolo, MD, Landis R. Walsh, BA, Gabrielle G. Massey, Brian I. Labow, MD.
Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
PURPOSE: Surgical correction of gynecomastia (male breast gland hypertrophy) improves adolescents' postoperative health-related quality of life (HRQoL). However, operating on adolescents remains controversial. This study examines the frequency of complications in adolescents following gynecomastia repair and measures their impact on patients' postoperative HRQoL.
METHODS: The following validated surveys were administered to patients between 12-21 years old undergoing surgical correction of gynecomastia: the Short Form-36v2 (SF-36), Rosenberg Self-Esteem Scale (RSES), and the Eating Attitudes Test (EAT-26). Surveys were completed at baseline, and 6 months, 1, 3, 5, and 7 years postoperatively.
RESULTS: Fifty-two patients were included, with a mean age at surgery of 16.8 years and median follow-up time of 17.7 months. Approximately a quarter of the cohort experienced a postoperative complication, most commonly: seroma/hematoma (21%), nipple or breast hypoesthesia (4%), and hypertrophic scarring (4%). Postoperative survey scores did not significantly vary by complication status across all survey measures (p>0.05, all). Patients without a complication showed significant postoperative improvements in 4 SF-36 domains (physical functioning, bodily pain, social functioning, and role emotional; p<0.05, all). Additionally, patients who experienced at least one complication demonstrated significant postoperative improvements in the vitality SF-36 domain, and on the RSES and EAT-26 (p<0.05, all).
CONCLUSIONS: Complications following gynecomastia repair are common. However, developing a complication does not appear to impact adolescents' overall postoperative HRQoL. Patients largely experience postoperative gains in psychosocial wellbeing regardless of complication status. Fear of potential complications should not preclude otherwise healthy adolescents from enjoying the benefits of surgical gynecomastia correction.
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