Liposuction Assisted De-Epithelialization Pull-Through Technique for Management of Grade IIB and III Gynecomastia

Document Type : Original Article

Authors

1 The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Mansoura University

2 The Department of General Surgery, Faculty of Medicine, Mansoura University

Abstract

Background: Gynecomastia is an abnormal and benign
enlargement of male breast tissue. It occurs as a result of an
imbalance between estrogen and androgen levels that may be
due to a physiological or pathological cause. Multiple surgical
approaches have been recommended to manage this problem.
It is widely accepted that liposuction solely or when combined
with subcutaneous mastectomy is effective for the management
of low to intermediate grades of gynecomastia. However,
liposuction along with subcutaneous mastectomy gives unsatisfactory
results in high grades where there is excess redundant
skin that needs excision. Several skin incisions have been mentioned
in literature for excision of excess skin, however, some
of these are accompanied by unaesthetic scars.
Objective: To assess the outcome of surgical correction of
high grades of gynecomastia in a single-stage procedure.
Patients and Methods: We conducted a prospective analysis
on 20 patients with grades IIb or III gynecomastia who underwent
single-stage procedures. Photographs were clinically
evaluated by two independent surgeons with respect to chest
contour, symmetry, scar, and residual ptosis. Patient satisfaction
was surveyed regarding chest contour and scar appearance.
Results: Statistical analysis revealed a significant improvement
in patient’s clinical measurements after operation,
good doctor’s scoring and patient satisfaction scoring among
studied cases, and accepted complication rates.
Conclusions: The current approach eliminates the need for
skin resection in a second surgery, permits immediate skin recontouring,
and achieves an acceptable aesthetic scar.

Keywords

Main Subjects

References

Cavina C.: Gynecomastia. InInternational Textbook of
Aesthetic Surgery (pp. 285-294). Berlin, Heidelberg:
Springer Berlin Heidelberg, 2016.
2- Morselli P.G. and Morellini A.: Breast reshaping in gynecomastia
by the “pull-through technique”: considerations
after 15 years. European Journal of Plastic Surgery, May
35: 365-71, 2012.
3- Persichetti P., Berloco M., Casadei R.M., Marangi G.F.,
Di Lella F. and Nobili A.M.: Gynecomastia and the complete
circumareolar approach in the surgical management
of skin redundancy. Plastic and Reconstructive Surgery,
Apr. 1; 107 (4): 948-54, 2001.
4- Webster J.P.: Mastectomy for gynecomastia through a
semicircular intra-areolar incision. Annals of Surgery,
Sep. 124 (3): 557, 1946.
5- Kasielska A. and Antoszewski B.: Surgical management
of gynecomastia: An outcome analysis. Annals of Plastic
Surgery, Nov. 1; 71 (5): 471-5, 2013.
6- Tashkandi M., Al-Qattan M.M., Hassanain J.M., Hawary
M.B. and Sultan M.: The surgical management of highgrade
gynecomastia. Annals of Plastic Surgery, Jul. 1; 53
(1): 17-20, 2004.
7- Ibrahiem SM.: Severe gynecomastia: New technique using
superior pedicle NAC flap through a circumareolar approach.
Annals of Plastic Surgery, Jun. 1; 76 (6): 645-51,
2016.
8- Fikry A. and Nasr M.: Surgical management of high grade
gynecomastia: Combination of liposuction, glandular resection
and a circumareolar skin reduction. The Egyptian
Journal of Plastic and Reconstructive Surgery, Jul. 1; 42
(2): 323-9, 2020.
9- Li C.C., Fu J.P., Chang S.C., Chen T.M. and Chen S.G.:
Surgical treatment of gynecomastia: Complications and
outcomes. Annals of Plastic Surgery, Nov. 1; 69 (5): 510-
5, 2012.
10- Swerdloff R.S. and Ng J.C.: Gynecomastia: Etiology, diagnosis,
and treatment. Endotext [Internet]. Jan 6, 2023.
11- Hurwitz D.J. and Davila A.A.: Contemporary management
of gynecomastia. Clinics in Plastic Surgery, Apr. 1;
49 (2): 293-305, 2022.
12- Cordova A. and Moschella F.: Algorithm for clinical evaluation
and surgical treatment of gynaecomastia. Journal of
plastic, reconstructive & aesthetic surgery, Jan. 1; 61 (1):
41-9, 2008.
13- Diyarbakirlioglu M., Ercan A. and Dogan Y.: Correction
of high-grade pseudogynecomastia after massive weight
loss: Modified inferior dermoglandular pedicled transverse
scar reduction. Aesthetic Plastic Surgery, Apr. 44:
435-41, 2020.
14- Cannistra C., Piedimonte A. and Albonico F.: Surgical
treatment of gynecomastia with severe ptosis: Periareolar
incision and dermal double areolar pedicle technique. Aesthetic
Plastic Surgery, Nov. 33: 834-7, 2009.
15- Botta S.A.: Alternatives for the surgical correction of severe
gynecomastia. Aesthetic Plastic Surgery, Jan. 22: 65-
70, 1998.
16- Beckenstein M.S., Windle B.H. and Stroup Jr. R.T.: Anatomical
parameters for nipple position and areolar diameter
in males. Annals of Plastic Surgery, Jan. 1; 36 (1): 33-6,
1996

Files

Share

How to cite

Statistics