Minimally invasive excision of gynaecomastia – a novel and effective surgical technique

Abstract

INTRODUCTION More aesthetically acceptable treatment options have been sought to minimise the morbidity associated with open surgery for gynaecomastia. This study investigated the use of a vacuum-assisted biopsy device (VABD) and liposuction to provide minimally invasive approach. PATIENTS AND METHODS Patients diagnosed with idiopathic benign gynaecomastia referred to the Breast Care Unit of Castle Hill Hospital between June 2002 and April 2007 and requesting surgical intervention underwent VABD excision and liposuction. All patients underwent thorough investigations to exclude any underlying cause for their gynaecomastia. The procedure was carried out by a single consultant surgeon with special interest in breast surgery. An 8-G mammotome probe was advanced through a 4-mm incision positioned in the corresponding anterior axillary line to excise the glandular disc. Liposuction was performed through the same incision. Incision wounds were closed with Steristrips. A pressure dressing was applied over wound by corset and an inflatable device. RESULTS Thirty-six male patients with grade I and II gynaecomastia were recruited (22 bilateral, 14 unilateral). Average age was 33.3 years (range, 16–88 years). All underwent mammotome excision and liposuction. There were no conversions to an open procedure. The average procedure time was 50.3 min (range, 30–80 min). One intra-operative complication was recorded. The minimum follow-up time was 2 months. Thirty-four patients reported excellent satisfaction, two patients had residual gynaecomastia and needed a re-do procedure. Three patients developed small haematomas that resolved spontaneously. CONCLUSION This novel, minimally invasive, surgical approach for gynaecomastia gives excellent results with minimal morbidity.

Multimodality Treatment of Gynecomastia in Patients Receiving Antiandrogen Therapy for Prostate Cancer in the Era of Abiraterone Acetate and New Antiandrogen Molecules

“…Despite progressive improvement, surgery is still associated with possible postoperative complications (hematomas, seromas), and often the final result is esthetically unsatisfactory because of the presence of asymmetry, scars or excessive residual skin [3]. In order to overcome the limits of a ‘classic’ approach, it has been tried to render surgical techniques less invasive; in addition to the ‘classic’ mastectomy, nowadays alternative techniques are available such as liposuction combined with subcutaneous mastectomy [16] and minimally invasive excision [17]. The former procedure is characterized by lower invasiveness and esthetically much appreciated results, but it does not completely eliminate the possible complications (such as altered peri-areolar sensation or keloid formation) of an open procedure, and it may also be slightly effective when fat excess has been definitely substituted by fibrosis.…”

Epidermal Cyst of the Breast Treated by Vacuum-Assisted Biopsy

“…11 Recently, VABD has been used for removal of benign breast lesions because the procedure is simple and less time-consuming. 12,13 It is also suitable for outpatient treatment under local anesthesia and causes minimal scarring.…”

Functional and Therapeutic Indications of Liposuction

“…56,59 Liposuction in combination with vacuum-assisted biopsy device (mammotome) has been also reported and may provide the same outcome. 60 As for female macromastia and gigantomastia frequently associated with significant symptoms such as neck and back pain, grooving of the shoulders from bras straps, and inframammary fold irritation and dermatitis, the standard treatment is surgical breast reduction. 7 Liposuction combined with traditional resection mammaplasty has been exploited for many years, allowing volume reduction before excision in addition to refining the results after excision as popularized by Lejour.…”