Educational Background
Plastic Surgery Residency Training, Universitas Indonesia
Fellowship in Hand & Microsurgery
Work Experience
Plastic Surgeon, Consultant in Hand & Microsurgery
Immediate Past President of OSAPS (Oriental Society of Aesthetic Plastic Surgery)
Educational Council Member of ISAPS (International Society of Aesthetic Plastic
Topic: Updates on Surgeries for Gynaecomastia
Abstract:
Gynecomastia is commonly found in the general population, with prevalence of more than 30%– where
most of them are physiologic. The trimodal age distribution is 90% of newborn male,50% of adolescents,
and 65% of adults above 50 years old. Physiologic cases are due to hormonal causes, including the
increase of estradiol concentration, lagging of free testosterone production, and increase of tissue
sensitivity to normal estrogen. On the other hand, non- physiologic gynecomastia cases are due to the
imbalance of estrogen and testosterone levels. Deficient of androgen action combined with excessive
estrogen action leads to breast enlargement. Moreover, other cases may be caused by metabolic,
neoplastic, drug-induced problems, or idiopathic gynecomastia, which accounts for 25% of cases. As
opposed to the glandular tissue, pseudogynecomastia is simply related to the adipose tissue. There are
several clinical grading systems for pseudogynecomastia and gynecomastia, such as Simon, Rohrich, and
other classifications proposed on the literature based on ultrasound imaging and zones of the breast.
Treatment is usually hormonal based, however surgery is often indicated for most cases. Goals of
surgical treatments are to achieve flatter, firmer, and more masculine chest contour. Numerous surgical
techniques are offered in the literature, but minimal scarring remains the ideal technique to achieve
optimal aesthetic outcomes. Two recent systematic reviews on pseudogynecomastia and gynecomastia
surgical techniques revealed that minimally invasive approach yields relatively good outcomes along with
high patients’ satisfaction. Therefore, semi-open technique facilitated by manual liposuction is
recommended as the approach to achieve the best outcome.
