Gynecomastia is the most common mammary pathology in men. It corresponds to a benign hypertrophy of the mammary gland. It results from an imbalance between testosterone and estrogen. We conducted a retrospective and descriptive study between September 1999 and October 2018, including all patients followed for gynecomastia in the Plastic, Reconstructive and Aesthetic Surgery Department of Dakar. The main objective was to evaluate the surgical management of patients. We collected 68 gynecomastia records representing 1.3% of the department's consultations. The average age was 22.6 years with extremes of 4 and 47 years. The majority of our patients consulted late with an average delay of 3 years and a half. The interrogation found a urogenital pathology in 9% of cases and a drug cause in 3% of cases. Psychological discomfort was present in all patients. Pain was noted in 7% of cases and seepage in 4%. Gynecomastia was bilateral in more than half of cases and the left side predominated in unilateral forms. Stage IIa Simon was the most common, found in 47% of cases. Few additional examinations were necessary. The surgical intervention rate was 48% of the affected breasts. Isolated mastectomy was performed in 75% of cases. Complications were benign in the vast majority of cases and only 1 case of under-achievement was noted. Gynecomastia is a benign pathology, having a very important psychological impact. Its management is mainly surgical and leads to a satisfactory aesthetic result.
Background Management of breast cancer remains challenging in underdeveloped countries such as Senegal. Diagnostic is often made late with locally advanced breast cancer. This causes difficulties with covering large defects after mastectomy. Through two observations we report the feasibility of covering large thoracic defects by an extended V-Y latissimus dorsi myocutaneous flap. Methods A retrospective study was carried out at the Department of Plastic Surgery of Dantec on patients with locally advanced breast cancer with predicted problems of wound closure after mastectomy. We used the extended V-Y latissimus dorsi myocutaneous flap. Results. These were two patients aged 45 and 57 years with both a T4dN1M0 breast cancer. Their breast cancer had resisted to chemotherapy. Mastectomies and lymph nodes removal were followed by immediate coverage with an extended latissimus dorsi V-Y flap. One patient had delayed wound healing due to lymphorrhea. Complete wound healing was achieved within 21 and 35 days. One patient died 2 years after surgery and the second is still alive after 18 months of follow up. Conclusion The extended V-Y latissimus dorsi myocutaneous flap is a good and safe option in covering defects left by extended mastectomy. Its morbidity is low and does not delay adjuvant chemotherapy and or radiotherapy.
Background: Necrotizing fasciitis (NF) is a severe, fulminant infection characterized by necrosis of subcutaneous tissue and fascia with associated systemic toxicity. Methods: A retrospective review of breast NF cases (January 2007 to December 2018) which originated primarily in breast tissue (PNF), or spread to the breast secondarily (SNF). Results: Five (63%) males and 3 (37%) females had an overall age (mean ± sd) of 46.4 ± 18 years, hospitalization 46.5 ± 20.3 days, and 10.4 ± 5.0 debriding/grafting. Females were older than males (median 51 vs 38 years). Six (75 %) patients had SNF and two (25%) had PNF with 5 partial, 2 unilateral, 2 bilateral and 1 simple mastectomies. Median age for PNF vs SNF patients was 72 vs 38 years. Bacteriology indicated: 3 cases of Group A Streptococcus pyogenes; 2 polymicrobial; 1 each of multiresistant Staphylococcus aureus, Pseudomonas, and Coagulase negative Staphylococcus. Overall mortality was 37.5%. Survivors were younger than the deceased 36.0 ± 10.3 (median 37) versus 63.7 ± 13.7 (70) years. Two patients with PNF had 100% mortality; only one of 6 (17%) SNF patients died. Conclusions: Although extremely rare, this institutional series had more males with breast NF than reported in the literature. Patients who developed breast NF secondarily were younger, with more partial mastectomies and lower mortality.
Introduction: Gynecomastia is an increase in breast volume in men. The surgical treatment consists of a glandular resection via the lower hemi-periareolar pathway, with or without liposuction. In case of moderate cutaneous excess, this gesture is completed by a skin lift by the technique of round-block. However, cases of major gynecomastia with significant ptosis generally require a mastectomy with reimplantation of the areola-nipple plate. Observations: We report the cases of 2 young adults with severe bilateral gynecomastia treated by a mastectomy with the repositioning of the areolar-nipple plate in the plastic surgery department of Aristide Le Dantec Hospital. Results: In postoperative period, one patient presented with unilateral hematoma and the other had a unilateral seroma, both of which were emptied. The aesthetic result was good and the patients were satisfied. Conclusion: Mastectomy followed by reimplantation of the areolar plate is the best option in the treatment of major gynecomastia.
