Re: Gynecomastia Surgery—Impact on Life Quality

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To the Editor:
We are grateful to Innocenti et al1 for their interest in our article and their comments related to the psychosocial aspects of gynecomastia surgical treatment.
We really appreciate the concept that the authors presented in their recent article, in which they grouped men with gynecomastia in 3 different categories according to their physical appearance and lifestyle.1 Similar to the results reported by the authors, we find patients with an athletic physique very difficult and demanding, because their expectations are greater than in subjects with a normal physique or in overweight patients. They seem to expect more than “normal male chest” and wish to achieve “perfect athletic chest” with no scars. We also observed that in recent years the number of such patients has increased. As a result, plastic surgeons look for less invasive techniques of gland removal, leaving less scars (eg, pull-though or shaver technique).2,3 Moreover, we fully agree with the authors' observation that in most of the cases extensive skin incisions is not required and that direct excision of glandular tissue ensures stable and satisfactory results.1 As we concluded together, management of patients' expectations seems to be the key to achieve a high level of patients' satisfaction.
As far as type of anesthesia is concerned, in our clinical practice, we did not observe any patients' complaints about the anesthesia type. We usually perform subcutaneous mastectomy using general anesthesia and, in case of less invasive procedures, local anesthesia plus sedation. The type of anesthesia is always discussed with the patient, and most of them choose general anesthesia. It would be worth to examine how men assess the comfort of different types of anesthesia in different types of surgical procedures performed in gynecomastia.
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