Role of combined circumareolar skin excision and liposuction in management of high grade gynaecomastia

Abstract

Introduction:High-grade gynaecomastia (Simon IIb and III) has tissue excess (skin excess, enlarged areola, and displaced nipple), which is best managed surgically; however, results of conventional breast reduction surgeries and liposuction is not very good. Aim of our study was to describe a combined technique to manage these problems to produce a good result.Material and Method:This was a 2-year study among 12 patients of high grade gynaecomastia. Clinical and laboratory findings were normal. Pre-operatively in standing position, diameter of breast and areola, position of nipple, and amount of skin excess were marked. Under general anaesthesia, tumescent infiltration, circumareolar de-epithelisation of skin excess, and liposuction was completed. Redundant portion of the breast was sharply dissected and pulled out. Areola was fixed over pectoralis fascia at mid humerus level, just medial to the mid-clavicular line. Outer borders of the de-epithelised area were apposed by the purse-string effect of a subdermal suture, and further apposed by few half buried horizontal mattress sutures. Drains for 24 hour and compressive dressings for 6 weeks were used.Result:Mean age of presentation was 25.8 year; emotional discomfort was the chief complaint. Among 12 patients, 10 patients had bilateral gynaecomastia and 8 patients had enlarged and displaced nipple-areola complex. Average hospital stay was 2.41 days and recoveries were usually uneventful.Conclusion:The problem of tissue excess and tissue displacement in high grade gynaecomastia can be well managed by this combined circumareolar skin reduction and liposuction technique to achieve a scar-less flat male chest.

Surgical Management of Gynecomastia: A Comprehensive Review of the Literature

“… 9 , 17 – 19 , 22 – 24 , 26 , 29 , 31 The next most common surgical procedure was MSR, which was performed by 8 of the authors. 18 – 20 , 23 – 25 , 27 , 28 MSR was most frequently reported to be used in patients with Simon grades II–III gynecomastia, with the exception of Wyrick et al 28 performing this technique in some grade I patients. In contrast, only 4 authors reported the use of liposuction alone.…”

Comparative Study between Peripheral Liposuction with Central Disk Excision Versus Subcutaneous Mastectomy Round Block Technique in Management of Gynecomastia

“…Management of gynecomastia is either followup for spontaneous regression, medical treatment and surgical treatment as mentioned in the literature.Surgical management is considered if gynecomastia persists for 18 to 24 months without spontaneous regression or not respond to medical treatment [10,11] .…”

Liposuction Versus Periareolar Excision Approach for Gynecomastia Treatment

“…[ 7 11 12 ] The surgical methods used for severe GM range from older techniques such as reduction mammoplasty with free grafting to currently used modified breast reduction techniques (no vertical scar or T-shaped scar pattern) or subcutaneous mastectomy with periareolar concentric skin excision. [ 13 ] Although these procedures might reduce breast size successfully, a high rate of undesirable outcomes has existed. [ 13 14 ] This study aimed to compare outcomes of liposuction with and without a periareolar incision in patients with gynecomastia.…”

“…[ 13 ] Although these procedures might reduce breast size successfully, a high rate of undesirable outcomes has existed. [ 13 14 ] This study aimed to compare outcomes of liposuction with and without a periareolar incision in patients with gynecomastia. However, the site of the liposuction and method of tissue excision was the novelty of our study.…”