One Stage Ultrasonic-Assisted Liposculpture Combined With Peri Areolar Surgical Gland Excision Without Skin Resection: Can Manage Sever Degrees of Glandular Gynecomastia?

Abstract

Background: Gynecomastia means abnormal hypertrophy of the male breast tissue. Gynecomastia is classified into 4 degrees, according to Simon et al., with grade 4 or III being characterised by marked glandular hypertrophy with skin excess. There are many procedures that are described in gynecomastia management as surgical excision, suctionassisted lipectomy, and ultrasound-assisted liposuction (UAL).Objectives: In our study, we will manage grade III cases with UAL only with peri-areolar surgical gland excision without skin excision procedure.Patients and Methods: Twenty-five cases were included in the study in the period from February 2019 to January 2021. It is a prospective study on grade III gynecomastia cases using UAL only with periareolar surgical gland excision without skin excision procedure. Results:The study encountered 25 cases, whose age ranged between 18 and 32 years old. All cases were grade III glandular gynecomastia. Operation time was varied, ranging from 1.5 hours to 2 hours. The amount of liposuction ranged between 400cc to 1300cc and the weight of the excised gland was between 20 and 55gm.Complications: 2 cases revealed seroma, which were managed by aspiration, and 1 case of saucer shape deformity due to over excision of reto-areolar glandular tissue. 1 case suffered from a decrease in nipple sensation which improved within 4 to 6 months post-operative. These complications occurred in 2 cases out of the 25 cases, with an overall success rate of 92%. No hematomas, infections, skin necrosis, asymmetry or skin redundancy were noticed. Conclusion:Ultrasonic-assisted liposculpture combined with periareolar surgical gland excision without skin resection procedure guarantees safe, effective, and satisfactory results in managing grade III idiopathic gynecomastia. No or minimal complications with minimal skin redundancy with good cosmetic results.