2023 General Surgery Presentations

Bobby Z Zhang, MD; James M Williams, MD; Hannah M Palmerton, MD; Grace E Pak, MD; Erik Q Roedel, MD; Jason R Bingham, MD; John M McClellan, MD; Madigan Army Medical Center

Objectives: The use of body armor and other equipment can cause significant pain and discomfort in military males with gynecomastia. As a result, simple mastectomies are routinely performed on service members suffering from this condition. Post-operative recovery, especially when there are complications, can negatively impact personnel readiness. In this study we sought to study time to recovery in active duty service members who undergo surgery for gynecomastia and the effect on personnel readiness.

Methods: We conducted a single center retrospective review of active duty patients undergoing a surgical operation for gynecomastia from July 2020 – June 2022. A total of 96 patients were included. Our primary outcome of interest was time from surgery to return to duty which was defined as medical clearance from surgeon or expiration of a physical profile. A multivariate analysis was performed to assess for factors independently associated with surgical complications including patient demographics and operative techniques.

Results: The median number of days to return to duty was 28 days (IQR 13-37). Surgical complications were observed in 19 patients (19.7%) with the most common complications being seroma (11), hematoma (4), NAC necrosis (2), and infection (2). 8 complications required interventions – 7 bedside procedures and 1 return to OR. 4 patients had chronic pain postoperatively. Patients with a complication have significant more time to return to duty (28 vs 49 days, p<0.001). Risk factors for increased risk of complication include BMI less than 27.0 (16% vs 36%, p<0.001, OR=1.8, 95% CI 1.1-3.3), behavioral health diagnosis (27% vs 52%, p<0.001, OR = 2.9, 95% CI 1.1-7.5), "open" vs "combined" technique with liposuction (15% vs 31%, p<0.001, OR = 2.0, 95% CI 0.9-4.7), length of operation greater than 58 minutes (15% vs 34%, p<0.001, OR = 3.0, 95% CI 1.1-8.0), and excised breast mass greater than 17.9 grams (14% vs 41%, p <0.001, OR = 4.2, 95% CI 1.5-11.6).

Conclusion: Gynecomastia surgery is associated with a detriment to personnel readiness. This is further exacerbated when complications occur as a result of the surgery. Risk factors for complications include BMI < 27.0, behavioral health diagnosis, surgical technique, length of operation > 58 minutes, and excised breast mass > 17.9 grams. ASA status, tobacco use, testosterone supplementation, resident experience, laterality, or drain usage were not associated with increased complication rate. Care must be taken to avoid complications to reduce the detriment to readiness.