Comment to: Is Breast Magnetic Resonance Imaging Superior to Sonography in Gynecomastia Evaluation and Surgery Planning

We read with great interest the article titled “Is Breast Magnetic Resonance Imaging Superior to Sonography in Gynecomastia Evaluation and Surgery Planning” by Xia Z et al. [1]. We congratulate with the Authors for highlightening Magnetic Resonance Imaging (MRI) as an adjunctive tool in preoperative investigation of gynecomastia, but we have some elements to discuss. The study of the glandular component, its distribution and its relationship with fat can certainly facilitate the planning of the surgery and consequently reducing complications and improving results. The gland represents one of the component of the disorder, but gynecomastia includes also fat tissue. Moreover, the presence of skin excess must be considered in male thorax recontouring. The surgical plane must consider all these components and taking into account patients’ expectation that often are not only related to the presence of the gland [2,3,4,5,6,7,8]. Although ultrasound (US) investigations could revel limits relied on the single different ultrasonologist experience, nevertheless it represents an exhaustive method in preoperative gynecomastia investigation. Therefore, considering its cost, time consuming and worsening of health care system’s waiting lists, MRI could result an excessive investigation. Based on our experience, clinical examination is strictly required in assessing the disorder, including visual and palpatory inspection, both in static and during muscular contraction. However, MRI offering more objective information in assessing gynecomastia tissue components, but we retain that it should be reserved in assistance of a very restrict of equivocal cases. Moreover, as stated in the paper, the discrepancy between MRI and US groups could represent a bias of the study. The median length of surgical procedure, reported in MRI group of patients resulted only five minutes shorter rather in the US group. Even if greater time saving was reported in surgical length procedures operated by the younger surgeons, could be fifteen-minute shorter time considered significant to justify MRI costs and time consuming disadvantages? The concordance between imaging results and intraoperative findings, as reported by the study, is 100% with MRI and 86.8% with US. Can this slight difference justify the use of MRI? Probably this low discrepancy could be improved with a meticulous ultrasonologists’ training. Although MRI could result useful in diagnosing and characterizing gynecomastia, currently its employment cannot be justified, since it provides only little more information than US and the surgeon's clinical assessment. References