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.