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A B Fig. 1. True gynecomastia in 47-year-old man A.

below the hypoechoic glandular tissues. C.

2 A B Fig. 1. True gynecomastia in 47-year-old man A. Ultrasonography shows a triangular shaped hypoechoic glandular tissues at left subareolar area (arrow). B. During US-guided mammotome excision, linear hyperechoic needle (arrow) is located below the hypoechoic glandular tissues. C. In histologic examination, terminal ducts (without lobule formation) are lined by a multilayered epithelium with small papillary tufts (arrow). There is typically surrounding periductal hyalinization and fibrosis. (H & E stain, 200) C 190

6 cm 11G Left 30 16 No 6 55 0.8 0.5 cm 8G Left 12 10 No 7 23 2.5 1.2 cm 8G Right 68 30 No 8 23 0.3 1.6 cm 8G Left 110 42 No 9 46 2.5 0.6 cm 8G Left 30 20 No Complication*: complication after the vacuum-assisted removal 3 & 6months.

3 Table 1. Summary of 11 Cases of US-Guided Vacuum-Assisted Removal of Gynecomastia Case Age Size Needle Location Pieces Time Complication* No. (min) 1 14 Not** 11G Right No Not** 11G Left No 2 19 Not** 11G Right No Not** 11G Left No cm 11G Right No cm 11G Right No cm 11G Left No cm 8G Left No cm 8G Right No cm 8G Left No cm 8G Left No Complication*: complication after the vacuum-assisted removal 3 & 6months. Not**: not measurable because of diffuse palpability d/t obesity A B Fig. 2. True gynecomastia in 28-year-old man. A. Initial ultrasonography shows a dendritic appearing hypoechoic glandular tissues at right subareolar area (arrow). B. Follow-up ultrasonography which is performed 6 months after the previous mammotome excision shows complete removal of the glandular tissues at subareolar area. 191

hypoechoic glandular tissues (arrow). B.

4 A B Fig. 3. Pseudogynecomastia in 19-year-old man. A. Initial ultrasonography shows a mainly fat tissues at subareolar area with scanty amounts of hypoechoic glandular tissues (arrow). B. Follw-up ultrasonography which is performed 6months after the previous mammotome excision shows no significant interval change of fatty tissue except disappearing hypoechoic glandular tissues. 192

5 M. The surgical management of high-grade gynecomastia. Ann Plast Surg 2004;53: Saad MN, Kay S. The circumareolar incision: a useful incision for gynaecomastia. Ann R Coll Surg Engl 1984;66: Fruhstorfer BH, Malata CM. A systematic approach to the surgical treatment of gynaecomastia. Br J Plast Surg 2003;56: Boni R. Tumescent power liposuction in the treatment of the enlarged male breast. Dermatology 2006;213: Hodgson EL, Fruhstorfer BH, Malata CM. Ultrasonic liposuction in the treatment of gynecomastia. Plast Reconstr Surg 2005;116: Bembo SA, Carlson HE. Gynecomastia: It s features, and when 12. Voigt M, Walgenbach KJ, Andree C, Bannasch H, Looden Z, Stark and how to treat it. Cleve Clin J Med 2004;71: GB. Minimally invasive surgical therapy of gynecomastia: liposuction and exercise technique. Chirurg 2001;72: Marthur R, Braunstein GD. Gynecomastia: pathomechanisms and treatment strategies. Horm Res 1997;48: Fine RE, Israel PZ, Walker LC, Corgan KR, Greenwald LV, 3. Gikas P, Mokbel K. Management of gynaecomastia: an update. Int Berenson JE, et al. A prospective study of the removal rate of imaged breast lesions by an 11-gauge vacuum-assisted biopsy probe J Clin Pract 2007;61: Courtiss EH. Gynecomastia: analysis of 159 patients and current system. Am J Surg 2001;182: recommendation for treatment. Plast Reconstr Surg 1987;79: Fine RE, Boyd BA, Whitworth PW, Kim JA, Harness JK, Burak 753 WE. Percutaneous removal of benign breast masses using a vacuum-assisted hand-held device with ultrasound guidance. Am J Surg 5. Neuman JF. Evaluation and treatment of gynenecomastia. Am Fam Physician 1997;55: ;184: Mentz HA, Ruiz-Razura A, Newall G, Patronella CK, Miniel LA. 15. March DE, Coughlin BF, Barham RB, Goulart RA, Klein SV, Bur Correction of gynecomastia through a single puncture incision. ME, et al. Breast masses: removal of all US evidence during biopsy Aesthetic Plast Surg 2007;31: by using a handheld vacuum-assisted device--initial experience. 7. Tashkandi M, Al-Qattan MM, Hassanain JM, Hawary MB, Sultan Radiology 2003;227:

6 The Role of Ultrasound-Guided Vacuum-Assisted Removal of Gynecomastia 1 You Me Kim, M.D. 1 Department of Radiology, Dankook University Hospital Purpose: To evaluate the role of performing ultrasound (US)-guided vacuum-assisted breast biopsies for the treatment (mammotome excision) of gynecomastia. Materials and Methods: Between November 2005 and December 2006, nine male patients underwent USguided mammotome excision for eleven cases of true gynecomastia. The patient ages ranged from 14 to 55 years (mean age, 32.3 years). US-guided mammotome excision was performed with an 11-gauge needle in seven cases and an 8-gauge needle in four cases. After the procedure, the cigarette method using gauze packing was performed. The number of samples, procedure time and presence of complications were evaluated. Scheduled follow-up physical and US examinations were performed after three and six months. Results: For 11 cases of US-guided mammotome excision of gynecomastia, the number of samples ranged from (mean, 66) and the procedure time ranged from minutes (mean time, 25.1 minutes). Clinical significant complications did not occur immediately after the procedure and complications were not seen after a follow-up examination in any of the cases. At the 3- and 6-month follow up examinations, all of the patients showed a normal male physical appearance on a physical examination and there was no evidence of hypoechoic glandular tissues as seen on ultrasonograms. Conclusion: US-guided mammotome excision is effective for the treatment of small, glandular true gynecomastia and is suggested as a new modality to replace the need for surgery or liposuction. Index words : Breast, ultrasonography Gynecomastia Mammography Vacuum curettage Address reprint requests to : You Me Kim, M.D., Department of Radiology, Dankook University Hospital 29 Anseodong, Cheonan, Choongnam, Korea. Tel Fax sirenos@hanmail.net 194

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황지웅 Comparison of Laparoscopy and Exploration in the Distal Pancreatectomy BACKGROUND: To determine the benefits of laparoscopic surgery compared with exploration, the clinical outcomes of open and laparoscopic