30. The reduction of drug-induced gynecomastia in hiv-positive adult man: A case report

Pham Thi Viet Dung, Truong The Duy

Main Article Content

Abstract

Gynecomastia is the most common benign disease in men due to many causes,including drug induced condition. This article introduces a 25-year-old male patient with breast enlargement after one year of HIV treatment with antiretroviral therapy. The patient was in stable condition and had surgery to remove the entire gland and excess skin to reconstruct the male breast shape with the technique of superomedial pedicle flap carrying the nipple-areola complex.. The right resected block weighed 800 grams and the left weighed 750 grams. After surgery, the wound  healed well, with complete survival of the nipple-areola complex. At  one year postoperative follow-up, breasts on both sides were flat, nipples were of suitable size, and good sensation. Treatment of gynecomastia with  breast reduction technique of the superomedial pedicle flap carrying the nipple-areola complex is ideal for aesthetic and restoration of nipple sensation. This technique performed on HIV patients with gynecomastia secondary to antiretroviral therapy in the stable stage can result in progression and recovery similar to patients with conventional breast hypertrophy reduction in women.

Article Details

References

1. Bowman JD, Kim H, Bustamante JJ. Drug-induced gynecomastia. Pharmacotherapy. 2012; 32(12): 1123-1140. doi:10.1002/phar.1138.
2. Nuttall FQ, Warrier RS, Gannon MC. Gynecomastia and drugs: a critical evaluation of the literature. Eur J Clin Pharmacol. 2015; 71(5): 569-578. doi:10.1007/s00228-015-1835-x.
3. Hershkovitz E, Leiberman E. Gynecomastia: A Review. The Endocrinologist. 2002; 12(4): 321-332.
4. Rohrich RJ, Ha RY, Kenkel JM, Adams WP. Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg. 2003; 111(2): 909-923; discussion 924-925. doi:10.1097/01.PRS.0000042146.40379.25.
5. Beckenstein MS, Windle BH, Stroup RT. Anatomical parameters for nipple position and areolar diameter in males. Ann Plast Surg. 1996; 36(1): 33-36. doi:10.1097/00000637-199601000-00007.
6. Sencha AN, Evseeva EV, Ozerskaya IA, et al. Anatomy, Physiology, and Development of the Male Breast. In: Sencha AN, ed. Imaging of Male Breast Cancer. Springer International Publishing; 2015: 17-23. doi:10.1007/978-3-319-06050-7_2.
7. Dimitrakakis C, Zhou J, Bondy CA. Androgens and mammary growth and neoplasia. Fertil Steril. 2002; 77 Suppl 4: S26-33. doi:10.1016/s0015-0282(02)02979-5.
8. Njuguna C, Swart A, Blockman M, et al. Cases of antiretroviral-associated gynaecomastia reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa. AIDS Res Ther. 2016; 13: 40. doi:10.1186/s12981-016-0121-z.
9. Shawarira-Bote S, Shamu T, Chimbetete C. Gynecomastia in HIV-positive adult men receiving efavirenz-based antiretroviral therapy at Newlands clinic, Harare, Zimbabwe. BMC Infect Dis. 2019; 19(1): 715. doi:10.1186/s12879-019-4332-5.
10. Qazi NA, Morlese JF, King DM, Ahmad RS, Gazzard BG, Nelson MR. Gynaecomastia without lipodystrophy in HIV-1-seropositive patients on efavirenz: an alternative hypothesis. AIDS Lond Engl. 2002; 16(3): 506-507. doi:10.1097/00002030-200202150-00033.
11. Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973; 51(1): 48-52. doi:10.1097/00006534-197301000-00009.
12. Tashkandi M, Al-Qattan MM, Hassanain JM, Hawary MB, Sultan M. The surgical management of high-grade gynecomastia. Ann Plast Surg. 2004; 53(1): 17-20; discussion 21. doi:10.1097/01.sap.0000112347.30612.f4.