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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "To limit postoperative morbidity, it is desirable and usually possible to employ a muscle-sparing approach, affording adequate exposure yet limiting or avoiding division of the serratus anterior and latissimus dorsi. The scapula is elevated off the chest wall by retractor to gain exposure, and palpation is used to count the ribs to the correct interspace. In most situations in infants, the highest palpable rib is the second. Generally, the fourth interspace is used for a lobectomy, although the fifth also can be used effectively."

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The breast tissue present in gynecomastia is most often tender, firm, and subareolar. One third of boys will present with unilateral gynecomastia. A mass in the breast that is not subareolar and is asymmetric should raise concern for other conditions. A testicular exam is a key component of the physical exam to rule out hypogonadism, suggestive of Klinefelter’s syndrome, a varicocele, or possible estrogen-secreting tumors of the testes, such as germ cell tumors, Sertoli cell tumors, or Leydig cell tumors."

video 1

video 1