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Breast enlargement, commonly referred to as breast augmentation, is a cosmetic operation intended to expand the breasts and improve breast enlargement. Typically, breast implants—devices filled with silicone or saline and inserted under the breast tissue or the chest muscle—are used in the procedure. The following are a few possible advantages of breast augmentation: Increased breast size: An increase in breast size is breast augmentation's most noticeable advantage. Based on their preferred look and the surgeon's advice, patients may choose the size of their implants. Breast augmentation may also be done to rectify asymmetry or give the breasts a fuller, more rounded look in order to enhance their form. Boosted self-confidence: Many women who have breast augmentation surgery claim an improvement in their self-esteem and contentment with their bodies as a consequence of the treatment. Improved clothing fit: Certain garments, such as skirts or tops with low necklines, might fit better when the wearer has larger breasts. Enhanced appearance in lingerie and swimwear: Breast augmentation may also make the breasts seem better in lingerie and swimsuits. Being a surgical operation, breast augmentation entails the risks and possible consequences that are common to all surgical procedures. Infection, hemorrhage, and scarring are a few of them. To reduce the danger of problems, it is crucial to choose a trained, experienced surgeon. Furthermore, breast implants might eventually need to be changed since they are not a permanent solution. The choice to replace breast implants should be based on the patient's particular requirements and objectives since the lifetime of breast implants varies. Overall, breast augmentation may be a secure and efficient approach to enlarge the breasts and enhance their form, but it's crucial to carefully weigh the risks and advantages before determining whether it's the correct treatment for you., breast enlargement

Purpose The purpose of this study is to examine the correlation between presenting clinical symptoms and imaging findings in men with breast cancer. Method and Materials Four hundred twenty-nine male patients who presented for mammography at one institution between January 2004 and December 2014 were retrospectively evaluated. Of the 429 patients, 291 presented with clinical symptoms for diagnostic mammography. The presenting clinical symptoms in 291 patients were recorded and correlated with imaging and histopathologic findings. Results Two hundred ninety-one male patients were included. Some presented with multiple symptoms, for a total of 318 clinical symptoms. One hundred and ninety (65%) men presented with palpable abnormalities, 44 (15%) with nonfocal pain, 31 (11%) with breast swelling, 14 (5%) with breast enlargement, 13 (4%) with focal pain, 7 (2%) with skin changes, 6 (2%) with nipple discharge/changes and 13 (4%) with other symptoms (itching, throbbing and breast heaviness). A total of 290 patients underwent mammography and 176 underwent sonography. Forty-one malignancies were diagnosed, of which 24 (59%) were invasive ductal carcinoma. Nipple changes/discharge had a 100% positive predictive value for malignancy while breast pain showed a 0% positive predictive value. Fifty-two patients showed either a mass or a focal asymmetry on mammography, of which 38 (73%) were malignant. Three patients (1%) without a mass or focal asymmetry were diagnosed with malignancy. Conclusion Correlating clinical symptoms and imaging findings can help with timely and accurate diagnosis of breast cancer in men. Nipple discharge/changes and skin changes with palpable abnormalities and mammographic findings of masses and focal asymmetries were associated with breast cancer. Pain, breast enlargement, and breast swelling were unlikely to be associated with malignancy

Background: Gynecomastia is defined as the presence of excessive breast tissue in males, which can appear unilateral or bilateral. Bilateral prepubertal gynecomastia in the absence of endocrine abnormalities is extremely rare, with only a few cases in literature. Case Presentation: A 46-year-old man presented with a 2 years history of bilateral breast enlargement and pain. There is heartburn, shrinking testicles, and decreased sexual drive. Vital examination showed normal. BMI : 24. 0 kg/m². Head dan neck: normal. On the chest both breasts are enlarged as avocados, palpable time around areola, chewy contingency, press pain, galactorrhea negative. Lung and cast are normal. In the abdominal: hepar, lien and renal are not palpable, and ascites are not found. There is an atrophy of testicles. Previous history of hepatic cirrhosis with Esophageal Varicose Veins caused by Hepatitis B. Laboratory examination Estradiol 98.71 pg/mL (range

Summary Adrenocortical carcinoma (ACC) is a malignant disorder with rapid evolution and severe prognosis in adults and most produce cortisol and androgen. Estrogen-secreting adrenocortical carcinomas are extremely rare, especially in women, tend to be larger and have worse prognosis compared with other types of ACCs. We report the case of a 58-year-old woman who presented with bilateral breast enlargement and postmenopausal genital bleeding. She presented high estradiol (818 pg/mL – 25 times above upper normal limit for postmenopausal women) and testosterone (158 ng/dL – 2 times above upper normal limit) levels and no suppression of cortisol after overnight 1 mg dexamethasone test (12.5 µg/dL; normal reference value: < 1.8 µg/dL). The patient had no clinical features of cortisol excess. MRI showed a 12 cm tumor in the right adrenal. Clinical findings of bilateral breast enlargement and postmenopausal genital bleeding with no signs of hypercortisolism associated with hormonal findings of elevated estradiol and testosterone levels would indicate either an ovarian etiology or an adrenal etiology; however, in the context of plasma cortisol levels non-suppressive after dexamethasone test and the confirmation of an adrenal tumor by MRI, the diagnosis of an adrenal tumor with mixed hormonal secretion was made. The patient underwent an open right adrenalectomy and pathological examination revealed an ACC with a Weiss’ score of 6. Estradiol and testosterone levels decreased to normal range soon after surgery. She was put on mitotane treatment as adjuvant therapy, but due to side effects, we were unable to up-titrate the dose and she never achieved serum mitotane dosage above the desired 14 µg/mL. The patient remained in good health without any local recurrence or metastasis until 5 years after surgery, when increased levels of estradiol (81 pg/mL – 2.5 times above upper normal limit) and testosterone (170 ng/dL – 2.1 times above upper normal limit) were detected. MRI revealed a retroperitoneal nodule measuring 1.8 × 1.2 cm. The pathological finding confirmed the recurrence of the estrogen-secreting ACC with a Weiss’ score of 6. After the second procedure, patient achieved normal estrogen and androgen serum levels and since then she has been followed for 3 years. The overall survival was 8 years after the diagnosis. In conclusion, although extremely rare, a diagnosis of an estrogen-secreting ACC should be considered as an etiology in postmenopausal women presenting with bilateral breast enlargement, genital bleeding and increased pure or prevailing estrogen secretion. Learning points: Estrogen-secreting adrenocortical carcinomas are exceedingly rare in adults and account for 1−2% of adrenocortical carcinomas. Estrogen-secreting adrenal tumors can be present in females, but are even more rare, we found few cases described in the literature. In women, they present with precocious puberty or postmenopausal bleeding. Feminization in the context of an adrenal tumor is considered almost pathognomonic of malignancy. Feminizing ACCs tend to be larger and with worse prognosis compared with nonfeminizing ACCs.

Pseudocyesis or false belief of pregnancy is the emergence of classical manifestations of pregnancy—nausea, breast enlargement and pigmentation, abdominal distention, amenorrhea, and labor pains—in a nonpregnant woman. It is a multifactorial disease and its development is influenced by many different elements such as neuroendocrine, social, psychodynamic, and cultural issues. “Folie-à-deux,” is shared psychotic disorder, describes a syndrome in which delusion is transferred to another person who is more susceptible. Both individuals are closely related or know each other for a long time and typically live together in relative social isolation. In its commonest form, the individual who first develops the delusion (the primary case) is often chronically ill and typically is the dominant member in a close relationship with a more suggestible person (the secondary case) who also develops the delusion. Treatment options should also be kept in mind as antipsychotics themselves can increase prolactin levels and can lead to amenorrhoea and galactorrhea and can further strengthen patient’s belief about her pregnancy. This case highlights that the most important therapeutic step in the treatment of folie-à-deux is separation of the inducer and the induced. Here we describe a case of folie-à-deux of a married couple in which the female had delusional pregnancy while the husband shared and supported her delusion against substantial medical evidence.

Objective: Gynecomastia is benign enlargement of breast in male. It is postulated that its development is primarily due to a mismatch in ratio of oestrogen and androgen at breast tissue. The aim of this study was to highlight the clinical features, presentation and hormonal parameters at the time of consultation. Methods: All adolescent patients who attended endocrinology department with the complaint of breast enlargement were taken into study. We analysed their thyroid function test, oestrogen, testosterone, prolactin, alpha-fetoprotein, follicle-stimulating hormone, luteinizing hormone, beta HCG (human chorionic gonadotropin) and liver function. Clinical features and anthropometry were recorded. Results: Out of 50 patients enrolled, 34 (68%) had bilateral gynaecomastia while 16 patients (32%) had unilateral disease. Mastalgia was seen in 44 patients (88%). Psychological disturbance in the form of depression was seen in 60% of adolescent boys with gynecomastia. Tanner stage B had positive correlation with oestrogen to testosterone (E2/TTE) ratio (r = 0.47; P = 0.034). All other hormonal parameters were normal. Conclusion: Mastalgia was one of the presenting complaints in majority of patients and many had bilateral enlargement. Altered oestrogen to testosterone ratio is altered in majority of patients thus may be reason for pubertal gynecomastia.

Gynecomastia is a common disease in male patients that is characterized by benign breast enlargement. Gynecomastia may involve fibroglandular tissue (FGT), supramammary fat tissue, and retromammary fat tissue (RMFT). Gynecomastia is usually treated surgically; however, some patients undergo reoperation because of dissatisfaction with the results of the first operation. This study aimed to analyze the breast conditions requiring reoperation and to identify factors requiring attention during the first gynecomastia surgery. We retrospectively evaluated 98 patients who underwent reoperation because of unsatisfactory esthetic outcomes from January 2014 to April 2020. According to the reasons for dissatisfaction, patients were divided into undercorrection and overcorrection groups. Patients with remnant breast tissue were assigned to the undercorrection group, while those in whom excess breast tissue was removed and was assigned to the overcorrection group. The undercorrection and overcorrection groups comprised 81 and 17 patients, respectively. In the undercorrection group, 49 (60.5%) patients had residual FGT and fat tissue necessitating simultaneous FGT excision and liposuction, while 32 (39.5%) patients had no residual FGT and were treated with liposuction only. In the overcorrection group, 13 (76.5%) patients had undergone excessive removal of RMFT at the inferolateral aspect of the pectoralis major muscle margin and were treated by autologous fat grafting. The most common cause of undercorrection was incomplete FGT removal, and the most common cause of overcorrection was excessive RMFT removal. Complete FGT excision and proper RMFT preservation can reduce the reoperation rate after gynecomastia surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Complete androgen insensitivity syndrome (CAIS) is caused by mutations in the androgen receptor gene. Patients with this syndrome have a 46,XY karyotype, male gonads, and normal female external genitalia. While the pre-pubertal risk of developing gonadal tumors is low in these patients, it increases with age. Most gonadal tumors arise from germ cells; stromal cell tumors are uncommon. Herein, we report a CAIS patient with a feminizing Sertoli cell tumor. The patient presented at 8 yr of age with breast enlargement and growth acceleration, concomitant with elevated serum estradiol levels and suppressed serum gonadotropin levels; these findings were inconsistent with CAIS. The patient underwent gonadectomy at 10 yr of age, and histology demonstrated presence of a non-malignant Sertoli cell tumor in the right gonad. We conclude that this is the first reported case of CAIS with accelerated onset of puberty resulting from a Sertoli cell tumor.

Introduction Most of patients undergo reduction mammaplasty for aesthetic or therapeutic reasons without consider the effect on breastfeeding function. Vertical scar mammaplasty with superior pedicle is expected to be a breast reduction procedure that can keep maintain the function of breastfeeding. This is the first recorded report of breastfeeding after vertical scar reduction mammaplasty with superior pedicle in Indonesia. Presentation of case A 23 years old woman presented to the outpatient clinic with enlargement of both breast for 3 years. Physical examination showed bilateral breast enlargement. No tenderness, nodules, nor axillary lymph node enlargement were found. The patient was managed with vertical scar mammaplasty with superior pedicle. The patient was followed up with complication of skin excess and scarring on the bilateral submammary folds. We performed excision and resection procedures to eliminate the skin excess and scars without further complications. The patient was married and gave birth to her first and second child after two and five years following mammaplasty. The patient was able to provide exclusive breastfeeding for both of her children. Discussion Vertical scar mammaplasty with superior pedicle surgery is a surgical technique that combines a superior pedicle for the areola and performs a central-inferior quadrant resection for breast reduction. It only takes the tissue and glands that are located in the lower quadrant and still maintains the surrounding tissue and glands. This technique also maintains the integrity of nipple-areola complex (NAC) which also important in the lactation process Conclusion Vertical scar mammaplasty with superior pedicle can be one of the superior techniques in breast reduction which can maintain the breastfeeding function thereby increasing patient satisfaction., Highlights • Breastfeeding after Vertical Scar Reduction Mammaplasty with Superior Pedicle: • This procedure only takes the tissue and glands that are located in the lower quadrant. • By preserving the superior pedicle it can maintains the integrity of nipple-areola complex (NAC). • Keep the breastfeeding function thereby increasing patient satisfaction.

Introduction. We report the first study on the prevalence of breast cancer in reduction mammoplasty specimens conducted in Limpopo province, South Africa. The prevalence of breast cancer is relatively low among pre-menopausal African women. Worldwide prevalence has been reported to range between 0.1% and 4.5%. Patients requesting reduction mammoplasty fear that their breast enlargement may be caused by the disease. Reduction mammoplasty is a common operation performed by plastic and reconstructive surgeons globally, but is an uncommon operation in Limpopo. Aims and objectives. To determine the prevalence of breast cancer in reduction mammoplasty specimens and to record the pertinent characteristics. Method. A prospective study of 104 female patients requesting reduction mammoplasty from 2007–2014 at Polokwane and Mankweng hospitals. The outcome measures were weight of specimens and histological investigation for breast carcinoma, body mass index and jugular–nipple distances. Results. All patients were of African origin whose median age was 32.4 (16–53) years, and median weight of excised tissue was 3.4 (1.45–6.2) kg. The median weight of patients was 77 (63–92) kg. The median BMI was 34.5 (29.1–39.9) kg/m2. The median jugular–nipple distance was 39 (25–51) cm on the right and 41 (29–53) cm on the left breast. Histological investigation revealed normal breast tissue in 57 cases, fibroadenosis in 25 cases, and duct hyperplasia in 22 cases. Conclusion. Breast cancer was not detected. The study population was relatively young at a mean age of 32.4 (16–53) years, without personal nor family history of breast cancer.

Highlights • This is one the first published cases of gestational gigantomastia in Saudi Arabia. • Gestational gigantomastia is a very rare disease (1 in 100 000 pregnancies). • This case of gestational gigantomastia is complicated by ulceration and discharge. • The treatment options are skin-sparing mastectomy and breast reconstruction. • Immediate reconstruction by pre-pectoral implant and ADM is an option., Introduction Gestational gigantomastia (GG) is a rare condition manifesting as a fast and excessive growth of the breasts in pregnant women. Its etiology is still unclear, with theories ranging from hormonal imbalances, unregulated immune response, to hypersensitivity. Medical interventions are mainly surgical in nature, though some pharmacological medications are of debatable efficacy. Case presentation A 33-year old Saudi gravida 3 para 2 presents continuous breast enlargement since the start of her pregnancy. She complains of skin ulcerations and discharge which was initially treated conservatively with topical antibiotics. Days after she came back with worsening GG symptoms, and was admitted for bilateral skin sparing mastectomy and reconstruction, and successfully recovered. The patient came back with problems concerning the surgical implant and wound infection. Emergency operation was performed for implant removal and wound treatment. Labor induction was performed by the OB-GYN on her 39 week. The patient opted for autogenous reconstruction by bilateral latissimus dorsi flap months after delivery. After treatment of minor surgical complications, the patient successfully recovered. Discussion Surgery is one of the most effective interventions for GG. Total mastectomy is preferred due to lesser risk of recurrence in subsequent pregnancies. Reduction mammoplasty offers the breastfeeding option if conducted before the delivery, but poses higher risk of recurrence in future pregnancies. Conclusion The patient’s gestational gigantomastia condition was complicated by several ulcerations and infections. Surgery was conducted alongside antibiotic treatment. This report also highlights the importance of follow ups in managing complications.

Gynecomastia presents the most common breast issue in men. It is defined as benign proliferation and enlargement of male breast glandular tissue that distributes most prevalently among neonates, adolescents, and elderly men. With a prevalence of over 60% in the male population, various classifications and treatment options have emerged to address male gynecomastia. Surgical treatment presents challenges and is used when gynecomastia has been present for several years or if medical therapy has been unsuccessful. We attempt to address some of these surgical challenges as they relate to aesthetic goals by presenting our surgical technique. Our surgical technique, the Tissue Resection Through Minimal Incision method, is described with illustrations included. Surgical candidates are selected after a review of the patient’s history, a thorough physical evaluation, obtaining any necessary imaging, and a detailed discussion with the patient. A hybrid, minimally invasive, and direct excision technique is used, including both standard VASER liposuction and direct glandular tissue resection via only a single 3-mm, well-hidden incision using simple instruments readily available with reproducible outcomes. We stress the idea of tissue inversion being key to make this feasible. Several case examples are presented with before and after comparisons, demonstrating good aesthetic results and skin retraction. In the more than 80 cases performed, one patient presented with dusky nipple areolar complex in the recovery room, which resolved with topical nitroglycerin. No nipple areolar complex necrosis occurred, nor hospitalizations were required for the cases performed. A few cases of tissue edema and swelling occurred correlating with inadequate compression or strenuous activity. Incisions were well hidden and aesthetically pleasing to patients. We briefly review gynecomastia classification and treatment options focused on surgical approaches. Of the various surgical methods available to treat gynecomastia, limitations and challenges include unfavorable scar and risk profiles, as well as inadequacy of tissue resection with the minimally invasive techniques. To meet this unmet need, our patented Tissue Resection Through Minimal Incision technique offers a novel minimally invasive approach that includes adequate tissue excision while maximizing aesthetic results and with nominal scarring. There is great need in surgical treatment of gynecomastia to minimize incisions and improve outcomes. Glandular tissue excision is a challenge to the cosmetic profile because of incisions used. Our novel technique and benefits involved address those concerns. However, our procedure does not address gynecomastia cases with excessive skin redundancy that requires excision. Further studies are still needed to address such challenges regarding aesthetic profile goals.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign hyperplastic condition of the breast that can lead to macromastia. The standard treatment for PASH is focal excision or rarely reduction mammoplasty. We present a rare case of postpartum bilateral rapid breast enlargement and axillary growth that was refractory to reduction mammoplasty. Ultimately, the patient required bilateral mastectomy and two-stage implant-based breast reconstruction. This more extensive form along with its management represents one of the few reported cases in the literature. The decision to pursue bilateral mastectomy was undertaken after exhausting more conservative options. Excellent aesthetic outcome and pain relief was obtained following definitive extirpative and reconstructive surgery.

Gynecomastia is the commonest clinical breast conditionin males. This study had described surgical approaches donefor different grades of gynecomastia. Eighty seven cases hadbeen operated for gynecomastia were analyzed in this studyfrom 2016 to 2019. One hundred and sixty three breasts, theclinical data regarding patients' satisfaction, breast size, breastssymmetry, shape and symmetry of the nipple areola complexand shape of their scars were evaluated. All cases were satisfiedabout the results of surgery; however patients with grade IVshowed concerns about scars. Plastic surgeons treat manymale patients that complain of breast enlargement and ask forsurgical correction of their deformities. A surgical algorithmis needed for management of different grades of gynecomastia.Breast size, glandular ptosis and skin redundancy are thecritical factors for the choice of the surgical technique

Galactocele is cystic dilatation of the mammary gland, which contains milk. Galactocele is usually presented as a painless breast enlargement with a fluctuant, soft, mobile, and non-tender mass in the breast. It is a rare disorder in the male pediatric age group, with only 31 cases reported in the literature. In this article, we present another case of unilateral galactocele in a 14-month-old male infant. Ultrasound imaging confirmed a simple cystic hypoechoic mass in the right breast, and needle aspiration was performed before surgery as a diagnostic procedure (a 1-cc extract revealed a milky-colored fluid).

Neonatal breast enlargement is a common condition as a normal response to postnatally falling maternal hormones. It can be seen in the first weeks and usually progresses during the first 2 months of life. We herein report a male newborn who was admitted with bilateral breast enlargement, diagnosed as neonatal “giant” mastauxe, and followed up without treatment. “Neonatal mastauxe” is the term used for physiological breast enlargement. It is important to differentiate neonatal mastauxe from mastitis or abscess. The parents should be informed about that it resolves without treatment over a few weeks of period, and they should be warned to avoid squeezing the breast. The most adequate approach is to observe the regression of breast swelling.

Rare condition characterized by an intensive and excessive breast enlargement is known as gigantomastia. Gestational gigantomastia manifests during pregnancy and could represent a life-threatening condition for both the mother and the fetus, therefore the risk of spontaneous abortion complicates the choice of treatment approach. We present a clinical case of a patient requesting medical assistance with a progressive breast growth. The onset occurred on the 5th week of gestation and, subsequently, was aggravated by distal tissue necrosis. The ambiguity of treatment approach in such situation is based on, on the one hand, the insecurity of watch-and-wait approach due to the high risk of septic complications and, on the other hand, the increasing danger of fetal loss in the case of surgical treatment during the first trimester of pregnancy. After an adequate assessment of mothers health state, a decision was made towards the wait-and-see tactic until the complete formation of the placental barrier. A total bilateral mastectomy was performed at the 19th week of pregnancy, with a favorable outcome for the patient and her child. This case emphasizes the significance of an individual, interdisciplinary approach to the choice of management for patients with this pathology.