Patients Decision-Making Characteristics Affects Gynecomastia Treatment Satisfaction: A Multicenter Study Using the BODY-Q Chest Module

Dear editors We read with great interest the article titled: “Patients Decision-Making Characteristics Affects Gynecomastia Treatment Satisfaction: A Multicenter Study Using the BODY-Q Chest Module” by Jørgensen MG et al. [1] As reported by the authors in the paper, patients’ preoperative decision making represents a sensitive item in patients affected from gynecomastia as their motivation is the main factor reflecting in personal perception of the final outcome with the result, resulting in patients exhibiting maximizing-type decision-making characteristics having worse satisfaction with gynecomastia treatment and poorer psychosocial health. We congratulate the authors for their interesting analysis of the preoperative psychological patients’ pattern and for its relationship with the satisfaction for the final outcome, but we have some elements to discuss. The preoperative severity of the gynecomastia disorder, as reported in the literature, is commonly graded taking into account the entity of the malformation including breast size, ptosis and skin quality and areolar disorder [2]. Each type of malformation requires a specific surgical approach, including different procedures such as liposuction, adenectomy, skin reducing, areolar reshaping and/or repositioning [3, 4]. Therefore, a preoperative assessment of the grade of gynecomastia in enrolled patients should be considered. [5] Since the severity of the disorder is strictly related to the final expectations, the relation between the preoperative classification and the reported satisfaction with the final results would have a stronger impact with the aim of the study. Preoperative physical condition reveals necessarily patients’ own attention to the body appearance; very defined muscular body type’s patients show a very sensitive care to the final results, evaluating more details rather than normal body type’s patients, and therefore, even minimal details, including minor NAC disorder, should be considered [6]. In their retrospective study, one of the most popular items of dissatisfaction with the result was the nipple areolar complex appearance, including projection, shape, size and irregularities, rather than chest appearance after thorax recontouring. Even in our experience, NAC appearance represents a very sensitive item. In enrolled patients, during the primary surgery did the authors plan the necessary correction of the eventual NAC disorder? This is a focal detail to enforce their postoperative survey. Since scarring represents a very common reason for claims, the quality and the extension of the scars should be carefully included in the retrospective analysis of the satisfaction with the chest appearance after gynecomastia surgery and therefore used surgical technique should be reported in the paper.