Bodybuilders who abuse anabolic steroids have a high incidence of gynecomastia. Reyes et al identified stages of progression and the appropriate management. The authors are from Guy's Hospital and Vision Powersport Clinic in London.
Diameter
Findings
Stage
<= 1 cm greater than nipple diameter
circumareolar halo or lateral ridge
1
1.01 to 6 cm greater than nipple diameter
no permanent skin distortion or stretching
2
> 6 cm greater than nipple diameter
permanent skin distortion and stretching
3
Stage
Management
Cosmesis
1
surgical excision under local anesthesia
excellent
2
may be suitable for surgical excision under local anesthesia depending on skill of surgeon
excellent to good
3
reduction mammoplasty with repositioning of the nipple
satisfactory to poor
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