Effects of Gynecomastia Surgery on Readiness and Return to Duty in an Active Duty Military Population

Bobby Zhang; Brendan Podszus; James Williams; Hannah Palmerton; Grace Pak; Erik Roedel; Jason Bingham; John McClellan

doi:10.1093/milmed/usad452

Effects of Gynecomastia Surgery on Readiness and Return to Duty in an Active Duty Military Population

Mil Med. 2023 Nov 22:usad452. doi: 10.1093/milmed/usad452. Online ahead of print.

Authors

Bobby Zhang¹, Brendan Podszus², James Williams¹, Hannah Palmerton¹, Grace Pak¹, Erik Roedel¹, Jason Bingham¹, John McClellan¹

Affiliations

¹ Department of General Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA.
² School of Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA.

PMID: 37995270
DOI: 10.1093/milmed/usad452

Abstract

Introduction: Simple mastectomies are routinely performed in the military health care system as gynecomastia can cause significant pain and discomfort when wearing body armor. Postoperative recovery negatively impacts personnel readiness. In this study, we sought to study time to return to duty in active duty service members who undergo surgery for gynecomastia.

Methods and materials: 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. 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 after surgery was 28 days (IQR 13-37). The median loss of duty days because of gynecomastia without surgery was 19 days (IQR 10-21), which was different on the Mann-Whitney U test. Surgical complications were observed in 19 patients (19.7%) with the most common complications being seroma (11), hematoma (4), nipple-areolar complex necrosis (2), and infection (2). Patients with a complication have significantly more time to return to duty (28 vs. 49 days, P < .001). Risk factors associated with an increased risk of complication include ranks E1-E4, behavioral health diagnosis, "open" vs. "combined" technique with liposuction, length of operation greater than 58 minutes, and excised breast mass greater than 17.9 g.

Conclusions: Gynecomastia surgery is associated with a detriment to personnel readiness. Surgery should be reserved for patients with severe symptoms that prevent the performance of daily duties. Furthermore, factors associated with an increased risk for complications include ranks E1-E5, behavioral health diagnosis, length of operation >58 minutes, and excised breast mass >17.9 g. The operating surgeon should be mindful of these factors.