Single‑incision surgery for gynecomastia using TriPort: A case report

Liu, Jian; Han, Yang; Chen, Kai; Wang, Xiaohong; Guo, Fei; Yang, Zhenlin

doi:10.3892/etm.2018.6224

Cited by 4 publications

(7 citation statements)

References 17 publications

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“…10 Minimally invasive methods, such as power-assisted liposuction and ultrasound-assisted liposuction techniques, have been beneficial in terms of minimal scarring; however, they are limited with mammary glandular tissue resection. 22,23 This has been evidenced as well in a study by Chang and Lee, 24 revealing a minimally invasive approach to scars; however, glandular tissue resection was ineffective with liposuction alone.…”

Section: Discussionmentioning

confidence: 84%

“…In 2017, Liu et al 22 described an innovative single-incision TriPort procedure that used endoscopy with CO 2 insufflation via a port and ultrasound knife for mammary tissue excision in addition to liposuction. While an effective technique for liposuction and tissue resection, a surgical drain was required due to the insufflated tissue expansion/dissection, and a large incision was required to accommodate the port (inner port diameters ranging 50-120 mm).…”

Section: Discussionmentioning

confidence: 99%

“…While an effective technique for liposuction and tissue resection, a surgical drain was required due to the insufflated tissue expansion/dissection, and a large incision was required to accommodate the port (inner port diameters ranging 50-120 mm). 22 This method also inadvertently requires extra endoscopic equipment to accommodate for insufflation of the tissue, as well as a learning curve to address potential tissue overresection during insufflated outbowing tissue and possible NAC saucer deformity. They presented a series of two cases and further cases may be needed to evaluate consistent replication of the results.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: The TRTMI Procedure, a Novel Surgical Technique for Gynecomastia

Nashed¹,

Branman²

2020

Am J Cosmet Surg

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Gynecomastia presents the most common breast issue in men. It is defined as benign proliferation and enlargement of male breast glandular tissue that distributes most prevalently among neonates, adolescents, and elderly men. With a prevalence of over 60% in the male population, various classifications and treatment options have emerged to address male gynecomastia. Surgical treatment presents challenges and is used when gynecomastia has been present for several years or if medical therapy has been unsuccessful. We attempt to address some of these surgical challenges as they relate to aesthetic goals by presenting our surgical technique. Our surgical technique, the Tissue Resection Through Minimal Incision method, is described with illustrations included. Surgical candidates are selected after a review of the patient’s history, a thorough physical evaluation, obtaining any necessary imaging, and a detailed discussion with the patient. A hybrid, minimally invasive, and direct excision technique is used, including both standard VASER liposuction and direct glandular tissue resection via only a single 3-mm, well-hidden incision using simple instruments readily available with reproducible outcomes. We stress the idea of tissue inversion being key to make this feasible. Several case examples are presented with before and after comparisons, demonstrating good aesthetic results and skin retraction. In the more than 80 cases performed, one patient presented with dusky nipple areolar complex in the recovery room, which resolved with topical nitroglycerin. No nipple areolar complex necrosis occurred, nor hospitalizations were required for the cases performed. A few cases of tissue edema and swelling occurred correlating with inadequate compression or strenuous activity. Incisions were well hidden and aesthetically pleasing to patients. We briefly review gynecomastia classification and treatment options focused on surgical approaches. Of the various surgical methods available to treat gynecomastia, limitations and challenges include unfavorable scar and risk profiles, as well as inadequacy of tissue resection with the minimally invasive techniques. To meet this unmet need, our patented Tissue Resection Through Minimal Incision technique offers a novel minimally invasive approach that includes adequate tissue excision while maximizing aesthetic results and with nominal scarring. There is great need in surgical treatment of gynecomastia to minimize incisions and improve outcomes. Glandular tissue excision is a challenge to the cosmetic profile because of incisions used. Our novel technique and benefits involved address those concerns. However, our procedure does not address gynecomastia cases with excessive skin redundancy that requires excision. Further studies are still needed to address such challenges regarding aesthetic profile goals.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Case Report: The TRTMI Procedure, a Novel Surgical Technique for Gynecomastia

Nashed¹,

Branman²

2020

Am J Cosmet Surg

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“…[ 3 , 12 ] Furthermore, a single port incision results in higher aesthetic outcomes even though a longer operative time might be needed. [ 7 ] Patients who underwent gynecomastia subcutaneous mastectomy through endoscopic axillary approach had higher scar satisfaction with better postoperative outcomes. [ 13 , 14 ]…”

Section: Discussionmentioning

confidence: 99%

“…There had been a few case reports of endoscopic subcutaneous mastectomy in higher-grade gynecomastia demonstrating better outcomes with less scarring, short operative time, minimal complications, and good esthetic results [3,12] . Furthermore, a single port incision results in higher aesthetic outcomes even though a longer operative time might be needed [7] . Patients who underwent gynecomastia subcutaneous mastectomy through endoscopic axillary approach had higher scar satisfaction with better postoperative outcomes [13,14] …”

Section: Discussionmentioning

confidence: 99%

Surgical management of complicated gynecomastia (associated with foreign body injection) with single-port 3-dimensional videoscope-assisted endoscopic subcutaneous mastectomy and concurrent liposuction

et al. 2021

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Rationale: Gynecomastia is a common benign breast disorder in men. Surgical management of gynecomastia includes that of a subcutaneous mastectomy with or without concurrent liposuction. Herein, the authors presented a case of complicated gynecomastia (gynecomastia with concurrent foreign body injection) which was successfully managed with an innovative technique that offered acceptable operative time, minimal complications, good recovery and satisfactory aesthetic outcome. Patient Concerns: A 39-year-old Taiwanese man who developed gynecomastia along with self-injection of foreign body (salad oil) over the past 10 years for breast enlargement presented as symptomatic bilateral breast lumps. Diagnosis: Bedside sonography revealed multiple large droplets of oil in the subcutaneous tissue bilaterally, resembling cystic lesions. Intervention: Bilateral single-port 3-dimensional videoscope-assisted endoscopic subcutaneous mastectomy was performed after bilateral breast liposuction. Operative findings include bilateral gynecomastia and previous bilateral breast foreign body material. The total weight of lipoaspirate was 400 grams and 300 grams for right and left side respectively. Subcutaneous mastectomy specimen weight was 820 grams and 661 grams for right and left breast tissue. Outcomes: Operative duration was 315 minutes and intraoperative blood loss at 150 ml. Patient was discharged 2 days after the operation, and subsequent follow up ultrasound showed complete removal of foreign bodies and fibrotic breast tissue. Patient was satisfied with the post-operative aesthetic outcomes. Lessons: Single-port 3-dimensional videoscope-assisted endoscopic subcutaneous mastectomy with concurrent liposuction is a promising and safe surgical option for patient with complicated gynecomastia and severe fibrosis.

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Pediatric endoscopic subcutaneous mastectomy (pesma) with liposuction in adolescents with gynecomastia

et al. 2022

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Background Surgical techniques for treatment of gynecomastia are increasingly less invasive. We described technical standardization of pediatric endoscopic subcutaneous mastectomy (PESMA) with liposuction. Methods All adolescents with primary gynecomastia, operated using PESMA with liposuction over the period June 2014–July 2021, were included. The video recording of procedures was analyzed to standardize the operative technique. After patient installation, 3 trocars were placed on the mid-axillary line. The technique included 5 steps: (1) subcutaneous injection of lipolysis solution and liposuction; (2) creation of working space using an inflated balloon; (3) gland dissection using 5-mm sealing device; (4) specimen extraction through the largest trocar orifice; and (5) placement of suction drainage tube. Results Twenty-four male adolescents, operated for Simon’s grade 2B and 3 gynecomastia using PESMA with liposuction over the study period, were included. Mean patient age was 16 years (range 15–18). Gynecomastia was bilateral in 19/24 (79.2%) and unilateral in 5/24 (20.8%). One (4.1%) conversion to open was reported. The mean operative time was 87 min (range 98–160) for unilateral and 160 min (range 140–250) for bilateral procedure. The mean length of stay was 2.2 days (range 1–4). Patients wore a thoracic belt for 15 up to 30 days postoperatively. Post-operative complications occurred in 5/24 (20.8%): 2- or 3 mm second-degree burns in 4 (16.7%) and subcutaneous seroma in 1 (4.1%). All complications were Clavien 2 grade and did not require further treatment. Aesthetic outcomes were very good in 21/24 (87.5%). Three (12.5%) boys had persistent minimal breast asymmetry but did never perceive it negatively. Conclusion PESMA combined with liposuction was feasible and safe for surgical treatment of gynecomastia in this selected cohort of patients. Although challenging, this procedure provided good aesthetic results, with no scars on the anterior thoracic wall. Standardization of the operative technique was a key point for successful outcome.

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Single‑incision surgery for gynecomastia using TriPort: A case report

Cited by 4 publications

References 17 publications

Case Report: The TRTMI Procedure, a Novel Surgical Technique for Gynecomastia

Case Report: The TRTMI Procedure, a Novel Surgical Technique for Gynecomastia

Surgical management of complicated gynecomastia (associated with foreign body injection) with single-port 3-dimensional videoscope-assisted endoscopic subcutaneous mastectomy and concurrent liposuction

Pediatric endoscopic subcutaneous mastectomy (pesma) with liposuction in adolescents with gynecomastia

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