Trends in the Surgical Correction of Gynecomastia

Liposuction versus Periareolar Excision Approach for Gynecomastia Treatment

Background

Gynecomastia (GM) is the increased fibroglandular tissue in the male breast by more than 2 cm, which is palpated under the nipple and areola. An ideal surgical approach aims to reduce the breast size, reach an acceptable breast shape, resect excessive glandular tissue, fatty tissue, and skin fatty tissue and excess skin, relocate the nipple-areolar complex, and avoid scars. Based on its importance, we aimed to compare outcomes of liposuction with and without periareolar incision in patients with GM.

Materials and Methods

This was a randomized clinical trial on patients referred for plastic surgery. Patients with GM were allocated into two treatment groups. Group A underwent liposuction without any areolar skin incision and group B had liposuction with the areolar skin incision. Patients were followed-up after surgery. Data were analyzed by Statistical Package for the Social Sciences (SPSS) version 20.

Results

Sixty patients aged between 20 and 27 years old participated in this study. Three hematomas, two surgical site infections, one nipple hypopigmentation after surgery, and one seroma formation were noted in group B. On the other hand, one hematoma and one seroma formation were noted in group A. The patients in group A were highly satisfied after the liposuction without skin incision procedure compared with group B (P = 0.01).

Conclusions

The management of GM by liposuction, either with the periareolar excision technique or without skin incision, allows the effective removal of fat and glandular tissue of the male breast. Although there was no significant difference regarding postoperation complications between groups, patients' satisfaction should be considered.

ECG Changes Occurring During Chest Liposuction for Gynecomastia - Artifacts or a Cause for Concern?

Currently, liposuction alone or combined with various methods of gland excision has become the standard of care in the surgical management of gynecomastia. Although liposuction is considered a safe and straightforward method of body contouring, serious complications related to the procedure, including deaths, have been reported in the literature. We report the occurrence of ECG artifacts intra-operatively while performing chest liposuction under general anesthesia. Patients may receive unnecessary and potentially dangerous therapeutic interventions if these ECG artifacts are not identified correctly. A careful and rational evaluation of the patient and the ECG by the clinician can accurately identify these pseudo-abnormalities and avoid unnecessary therapies.

Surgical Management of Gynecomastia: A Comprehensive Review of the Literature

Gynecomastia is a graded condition characterized by enlargement of the male breast that affects a significant proportion of the male population. A plethora of varying surgical approaches currently exists in the literature; thus this comprehensive review sought to analyze surgical practice patterns and trends as they pertain to gynecomastia grade and severity. The current literature was queried utilizing the PubMed and MEDLINE databases—based on predefined parameters and individual review, 17 studies were ultimately included. Key data points included gynecomastia grade, surgical intervention, rate of complication, including hematoma, seroma, infection, and necrosis, and drain use. Two-sample t test was utilized for further analysis. A total of 1112 patients underwent surgical treatment for gynecomastia. Skin-sparing mastectomy with or without liposuction was the most frequently used procedure followed by mastectomy with skin reduction. Major complication rates ranged from 0% to 33%, with hematoma formation being most common (5.8%) followed seroma (2.4%). There was a higher rate of hematoma/seroma formation among authors who routinely utilized drain placement (9.78% versus 8.36%; P = 0.0051); however, this is likely attributable to the large discrepancy in percentage of grade III patients found in each group (50.23% versus 4.36%; P = 0.0000). As a wide variety of surgical techniques exist for the treatment of gynecomastia, an individualized approach based upon gynecomastia grade and patient preference may assist the surgeon in providing optimal outcomes. This senior author’s preferred method for treatment of gynecomastia is illustrated in the included algorithm.

Anabolic-androgenic Steroid Use Among Gynecomastia Patients: Prevalence and Relevance to Surgical Management

BACKGROUND

Anabolic-androgenic steroids (AAS) are widely implicated in gynecomastia development. Surgery is the definitive treatment for cases persisting after cessation of AAS use. Currently, the relevance of AAS use to the surgical approach of gynecomastia has not been well explored. This study aims to compare patient characteristics, surgical outcomes, and surgical management of gynecomastia correction in AAS users versus nonusers.

METHODS

A retrospective cohort study was performed with patients who underwent bilateral gynecomastia reduction surgery between January 2005 and August 2015 by a single surgeon at an academic hospital. Demographic data, AAS usage details, operative documentation, and follow-up outcomes were reviewed.

RESULTS

A total of 964 cases were reviewed. Eleven percent (n = 105) of the patients had a history of AAS use. Compared with non-AAS users, AAS users were older at time of gynecomastia onset (15 years vs 13 years, P < 0.001) and surgery (28 years vs 25 years, P < 0.001). The AAS users had higher body mass index (27.3 kg/m vs 25.7 kg/m, P < 0.001) and a greater proportion of patients self-identified as bodybuilders (40.0% vs 22.4%, P = 0.002). Although no difference was found in the excised bilateral mastectomy volume (92.1 cm vs 76.4 cm, P = 0.20), The AAS users had significantly less lipoaspirate fat volume (250 mL vs 300 mL, P = 0.005). No difference was found in total complication rates. However, AAS users had significantly more revision mastectomy surgeries (3.8% vs 1.1%; P = 0.02).

CONCLUSIONS

The unique breast composition of AAS users necessitates a surgical approach with meticulous intraoperative hemostasis and careful glandular excision to minimize recurrence and achieve comparable low complication rates.

Liposuction in Gynecomastia: An Assessment of the Suction-assisted Arthroscopic Shaver Versus Open Disc Excision Techniques

Introduction

Gynecomastia is a common problem of the male breasts, which imposes a great psychological burden on patients. It is mostly bilateral and frequently asymmetrical. Surgical management of gynecomastia has undergone significant changes over the past few decades. Currently, the predominant mode of treatment includes liposuction of the fibro-fatty tissue either alone or in combination with the removal of the glandular tissue by the open excision technique or arthroscopic shaver. This study aims to compare both techniques in terms of hematoma formation, nipple necrosis, reoperation, contour irregularities, acceptability of scarring, asymmetry, and patient satisfaction.

Methods

The study has been conducted at Shifa International Hospital, Islamabad, from May 2018 to September 2019. Sixty patients were included in the study. All the patients had bilateral gynecomastia and Simon’s Grade II-A or II-B. The study sample was divided into two equal groups. Group A underwent liposuction combined with open disc excision while Group B underwent liposuction coupled with disc excision via suction-assisted arthroscopic shaver. Postoperatively, all the patients received follow-up for a minimum period of six months.

Results

In a cohort of 60 patients, the mean age was 25.76±5.38 years. There were minor differences noted in terms of hematoma formation, nipple necrosis, rates of re-operation, and contour irregularities between open disc excision and arthroscopic disc excision, respectively (p-value > 0.05). About eight patients reported asymmetry in open disc excision as compared to 10 in arthroscopic disc excision. The acceptability of scarring was reported as equal in both groups. Mean patient satisfaction was based on the visual analog scale (VAS) scale was 8.25 in both groups. No statistical difference regarding patient satisfaction was noted in both groups (p-value 0.126).

Conclusion

Our study concludes that arthroscopic shaver-assisted disc excision despite being a novel and minimally invasive technique does not hold superiority over conventional open disc excision for the management of gynecomastia. Furthermore, in a developing country like Pakistan, there is a lack of expertise with the procedure and a need for more training among plastic surgeons.

Application of the Lalonde (horizontal-only scar) breast reduction technique for correction of gynaecomastia in dark skinned patients

Surgical correction of gynaecomastia correction sometimes necessitates skin reduction in addition to resection of glandular tissue and liposuction of the fat deposits. Many skin reduction techniques have been described but all suffer from very noticeable and often poor scars that can manifest as hypertrophic or keloid scars in patients with dark skin. Three large gynaecomastia patients undergoing a modification of the Lalonde "no vertical scar" breast reduction technique designed to reduce the extent of scarring were reviewed. The Lalonde "no vertical scar" technique was successfully applied to three patients of African extraction with acceptable postoperative scarring. A description of the technique and the cosmetic results are presented. The Lalonde technique of female breast reduction can be applied to the treatment of male breast enlargement in patients at high risk of scar complications. It provides an alternative to the more widely used concentric skin reduction techniques. To our knowledge, this is the first report in literature of the application of the Lalonde "no vertical scar" surgical technique to the treatment of gynaecomastia in patients with darkly pigmented skin.

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

Gynecomastia is a common benign condition of the male breast, frequently observed in newborns, adolescents and the elderly. Surgical excision remains one of the most effective methods for the management of patients with gynecomastia, particularly those with fibrosis or a course of >1 year. The present study describes two cases of patients with gynecomastia and presents a novel method of treatment, combining endoscopic surgery and liposuction using a TriPort, which may effectively remove breast tissue and shorten hospitalization time compared with a direct excision method.