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Wijesinghe K, Abeywickrama T, Chandraguptha BDMR, Sathasivam K, Jayarajah U, De Silva A. Experience in the use of circular incision bi-pedicled vertical flap based mastectomy for grade III gynecomastia: A case series. Int J Surg Case Rep 2024; 122:110129. [PMID: 39128212 DOI: 10.1016/j.ijscr.2024.110129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/28/2024] [Accepted: 08/06/2024] [Indexed: 08/13/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Surgical management of grade III gynecomastia with excess redundant skin is challenging. The choice of the surgical technique is mainly decided upon the size of the gynecomastia, the skin redundancy and correction of nipple position. CASE PRESENTATION We report our experience in the use of the circular incision bi-pedicled vertical flap based mastectomy for grade III gynecomastia according to Simon classification. This is a retrospective study conducted between January 2022 and April 2023 at two selected units in Sri Lanka. CLINICAL DISCUSSION A total of 7 patients with bilateral grade III gynecomastia were included in this study with a median age of 24 years (range: 18-42 years). The mean BMI was 23.2 kg/m2. All patients exhibited near symmetrical breasts and large areolar diameters. All patients complained of physical and psychological dissatisfaction with their condition and sought an aesthetic correction. Two patients were diagnosed with Klinefelter syndrome and others were apparently healthy. The main complication was seroma formation (7/7). No patients developed haematoma. Nipple hypothesia was noted in two patients which improved on follow up. The mean follow- up duration was 4-9 months. The survey of patient satisfaction showed 9 for contour, 8.6 for wound scars, 9.2 for overall satisfaction and 9.6 for improvement in self-confidence. CONCLUSION The above surgical technique achieved satisfactory aesthetic results while avoiding unsightly scars or serious complications and can be considered in the surgical decision making for grade III gynecomastia.
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Affiliation(s)
- Kanchana Wijesinghe
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka.
| | | | | | | | - Umesh Jayarajah
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Ajith De Silva
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Tambasco D, Albanese R, Scarabosio A, Tomaselli F, Parodi PC. A Three-Dimensional Approach To Male Chest Enhancement: A Surgical Algorithm Based On 300 Cases. Aesthetic Plast Surg 2024; 48:3646-3655. [PMID: 38777928 DOI: 10.1007/s00266-024-04063-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024]
Abstract
Gynecomastia is defined as a benign condition of the male caused by tissue overgrowth (Blau and Hazani in Plast Reconstruct Surg 135(2): 425-432, 2015). Its incidence ranges widely in the world population, ranging from 32 to 65% (Innocenti et al. in Ann Plast Surg 78(5):492-496, 2017). Pseudogynecomastia is a condition characterized by deposits of adipose tissue with alteration of the profile of the male thorax. It appears clinically similar to gynecomastia (Hoyos et al. in Plast Reconstr Surg 147:1072-1083, 2021). Several classification systems that characterize the severity of male breast hypertrophy have been described in the literature, and many surgical algorithms have been formulated for its treatment (Holzmer et al. in Plast Reconstruct Surg-Global Open 8:e3161, 2020). The purpose of this original article is to provide a comprehensive surgical algorithm for the management of male chest enhancement based on severity, as defined by the Moschella scale (Tambasco et al. in J Plast Reconstruct Aesthet Surg 90:99-100, 2024). A total of 300 patients treated for bilateral breast hypertrophy are included and reviewed in this retrospective study. Patients have been diversified according to the Moschella scale. For each grade up to grade III, two subgroups were distinguished: A) pinch test less than 0.7 cm and B) pinch test greater than 0.7 cm. For Grade IV, we distinguished: subgroup A) where the distance between the inframammary fold and the nipple was < 3 cm; and subgroup B) where the distance between the inframammary fold and the nipple was > 3 cm. We developed an algorithm, based on this experience, to help to choose the best surgical techniques to perform a three-dimensional result. All patients were treated using multiple surgical techniques. In all cases, we made a reduction in the hypertrophy of the chest, obtaining the three dimensionality. Associate techniques include ultrasound-assisted liposuction (UAL) and helium plasma radiofrequency technology (HPRF). A round block mastectomy (RBm) or skin-reducing mastectomy T inverted (SRM Tinv) is reserved only in limited cases.Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Roberta Albanese
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine,, University of Udine, Udine, Italy.
- Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, UD, Italy.
| | - Anna Scarabosio
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine,, University of Udine, Udine, Italy
| | | | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine,, University of Udine, Udine, Italy
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Zbar RI, Richards CR, Durbin RR, Wellington JM. Balancing Expectations: Navigating Medically Necessary Torso Procedures with Cosmetic Components in the Military Healthcare System. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5954. [PMID: 38983946 PMCID: PMC11233100 DOI: 10.1097/gox.0000000000005954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024]
Abstract
Background Surgeons performing federal insurance-financed procedures involving medically necessary and cosmetic components must navigate patient expectations to avoid postoperative disappointment. This challenge is amplified in military healthcare, where different surgical specialties concurrently address the same diagnosis, while the Department of Defense policy on cosmetic fees and TRICARE's definition of excluded services adds further complexity. With the increasing prevalence of elevated body mass index, focus is directed toward diagnoses involving the torso, specifically gynecomastia in male individuals, and diastasis of the rectus abdominis muscles (DRAM) in female individuals. Methods The study involves a team of experienced board-certified surgeons conducting a narrative review of surgical procedures addressing gynecomastia and DRAM. Relevant literature from 2000 to 2023 is reviewed, focusing on patient satisfaction regarding outcome of medically necessary and cosmetic aspects. Results For gynecomastia, distinguishing between true and pseudogynecomastia is critical. A protocol is presented based on the Simon classification, offering evidence-based guidelines for surgical interventions. Similarly, for DRAM, a minimally invasive approach balances deployment readiness and surgical recovery. The presence of a symptomatic panniculus, however, requires more invasive intervention. The downstream ramification of limited Current Procedural Terminology codes for these interventions is discussed. Conclusions In medically necessary procedures funded through federal health plans such as TRICARE, the primary goal is functional improvement, not the final torso contour. Clear communication and preoperative counseling are crucial to managing patient expectations. Providers in military healthcare must navigate the complex landscape of patient expectations, policy guidelines, and duty readiness while maintaining the standard of care.
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Affiliation(s)
- Ross I.S. Zbar
- From the Division of Plastic Surgery, Martin Army Community Hospital, Fort Moore, Ga
| | - Carly R.N. Richards
- Division of General Surgery, Department of Surgery, Martin Army Community Hospital, Fort Moore, Ga
| | - Ronald R. Durbin
- Division of General Surgery, Department of Surgery, Martin Army Community Hospital, Fort Moore, Ga
| | - Jennifer M. Wellington
- Division of General Surgery, Department of Surgery, Martin Army Community Hospital, Fort Moore, Ga
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Belza CC, Blum JD, Neubauer D, Reid CM, Ortiz-Pomales YT, Lance SH. A Retrospective Review of Arthroscopic Shaver Utilization in Adolescent Gynecomastia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5336. [PMID: 37829108 PMCID: PMC10566858 DOI: 10.1097/gox.0000000000005336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 08/24/2023] [Indexed: 10/14/2023]
Abstract
Background This study compares the arthroscopic shaver and liposuction with other established methods for treatment of adolescent gynecomastia. Methods Surgical management was via four operative techniques: open excision, open excision/liposuction, arthroscopic shaver/liposuction, or open excision and free nipple graft. Data were collected and compared using independent t tests, linear regression models, and one-way analysis of variance. Results Patients were stratified by Rohrich grades I -II (low) (N = 47) or III -IV (high) (N = 13). The groups were similar in age (P = 0.662) with lower BMI in the low-grade group (x̄ = 25.36 ± 2.1) vs. high-grade group (x̄ = 27.62 ± 4.0; P < 0.001). The low-grade group showed no significant difference in operative time across surgical techniques with decreased mean operative time in the high-grade group using the arthroscopic shaver technique (x̄ = 55.8 ± 7.56) compared with open excision (x̄ = 70.83 ± 11.02, P = 0.04), open excision plus liposuction (x̄ = 89.5 ± 24.93, P = 24.93), and open excision plus free nipple graft (x̄ = 81.67 ± 19.11, P = 0.05). There was no significant difference in complication (P = 0.84) or reoperation (P = 0.68) rates across surgical techniques regardless of grade. Conclusions These findings suggest that the arthroscopic shaver is safe and effective for treatment of both low- and high-grade gynecomastia in adolescents. The results yielded a similar incidence of complications and reoperation across surgical techniques, and the arthroscopic shaver approach demonstrated a shorter operative time compared with other techniques for high-grade gynecomastia.
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Affiliation(s)
- Caitlyn C. Belza
- From the School of Medicine, University of California San Diego, San Diego, Calif
| | - Jessica D. Blum
- From the School of Medicine, University of California San Diego, San Diego, Calif
| | - Daniel Neubauer
- Division of Plastic Surgery, University of California San Diego, La Jolla, Calif
- United States Navy, Naval Medical Center San Diego, San Diego, Calif
| | - Christopher M. Reid
- Division of Plastic Surgery, University of California San Diego, La Jolla, Calif
| | | | - Samuel H. Lance
- Division of Plastic Surgery, University of California San Diego, La Jolla, Calif
- Rady Children’s Hospital San Diego, San Diego, Calif
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Ramasamy K, Tripathee S, Murugesh A, Jesudass J, Sinha R, Alagarasan AR. A Single-Center Experience With Gynecomastia Treatment Using Liposuction, Complete Gland Removal, and Nipple Areola Complex Lifting Plaster Technique: A Review of 448 Patients. Aesthet Surg J Open Forum 2023; 5:ojac095. [PMID: 36866186 PMCID: PMC9972507 DOI: 10.1093/asjof/ojac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Gynecomastia is defined as a benign enlargement of male breast glandular tissue. It is the most common breast condition in male, and the prevalence ranges from 32% to 72%. No standardized treatment exists for gynecomastia. Objectives The authors treat gynecomastia patient with liposuction and complete gland excision through periareolar incision without skin excision. In case of skin redundancy, the authors use their special technique called nipple areola complex (NAC) plaster lift technique. Methods The authors conducted the retrospective analysis of patient who underwent gynecomastia surgery between January 2020 and December 2021 at Chennai Plastic Surgery. All patients were treated with liposuction, gland excision, and NAC lifting plaster when required. The follow-up period ranges from 6 to 14 months. Results A total of 448 patients (896 breasts) were included in our study with average age of 26.6 years. Grade II gynecomastia was most common in our study. The average BMI of the patients was 27.31 kg/m2. One hundred and sixteen patients (25.9%) experienced some form of complication. Seroma was most common complications in our study followed by superficial skin necrosis. Patient satisfaction rate was high in our study. Conclusions Gynecomastia surgery is safe and highly rewarding procedure for surgeons. Various technologies and methods like liposuction, complete gland excision, and NAC lifting plaster technique should be adopted in gynecomastia treatment to give a better patient satisfaction. Complications are common in gynecomastia surgery but easily manageable. Level of Evidence 4
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Affiliation(s)
- Karthik Ramasamy
- Corresponding Author: Dr Karthik Ramasamy, New No. 12, Old, 10, Mc Nichols Rd, 4th Lane, Chetpet, Chennai, Tamil Nadu 600031, India. E-mail:
| | | | | | | | - Rakesh Sinha
- Plastic surgeons in private practice in Chennai, India
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Karamchandani MM, De La Cruz Ku G, Sokol BL, Chatterjee A, Homsy C. Management of Gynecomastia and Male Benign Diseases. Surg Clin North Am 2022; 102:989-1005. [DOI: 10.1016/j.suc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ramasamy K, Jagadish Kiran ACV, Jesudass J, Raj S. NAC Plaster Lifting Technique for the Management of Skin Redundancy in Severe Gynecomastia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4339. [PMID: 35620491 PMCID: PMC9119640 DOI: 10.1097/gox.0000000000004339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/01/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Gynecomastia is found to be a common cosmetic problem. Many techniques are currently available for the surgical treatment of gynecomastia, reported to be effective, with limited scar formation. The main objective of our unique reproducible nipple-areola complex (NAC) lifting technique is the management of skin redundancy in severe gynecomastia and positioning the NAC at an aesthetically pleasing site on the chest, for men. METHODS A retrospective study was conducted in 30 gynecomastia surgeries of grade III and IV done from January 2019 to December 2020. All these patients were treated by using the NAC lifting technique in our centre, and the results were assessed with patient and surgeon satisfaction scores. This lifting plaster technique is used after the skin closure of the Webster incision. The U slit in the lifting plaster prevents the wrinkling of the NAC and also avoids the second stage surgery for most of the cases of severe gynecomastia. RESULTS A retrospective analysis showed that all patients were satisfied with the technique and none of the patients returned for the second stage surgery. Minimal residual skin redundancy was observed, but it was not severe to necessitate a secondary procedure. All patients were satisfied and comfortable with the final outcome.There was no incidence of contour deformity after the procedure. CONCLUSION This technique takes advantage of the elastic recoiling property of the skin and helps in re-draping the redundant skin on the chest wall and in positionining the NAC at an aesthetically pleasing position on the chest.
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Affiliation(s)
| | | | | | - Sunitha Raj
- Chennai Plastic Surgery, Chennai, Tamil Nadu, India
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Caridi RC. Total Gynecomastia Removal with Layered Closure: A Study of 567 Cases. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4256. [PMID: 35433158 PMCID: PMC9007201 DOI: 10.1097/gox.0000000000004256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
Conventional teaching dictates subtotal removal of gynecomastia tissue to ensure a cosmetically acceptable result. Modern-day concerns regarding gynecomastia treatment include continued "puffy nipples," possible recurrence, and compromised aesthetic results resulting from incomplete tissue removal. The author practiced complete tissue removal with a layered closure technique to optimize the cosmetic result while addressing treatment complications. Methods A single surgeon treated 567 patients using a standard four-step approach with complete tissue removal. A retrospective chart review was performed to assess complications and reason for surgical revision. Results All revision procedures were for postoperative scar tissue accumulation. No revisions for complaints of contour depression, recurrence, or continued puffy nipples were noted. No necrosis of the nipple-areola complex or skin was noted. Conclusions Complete removal of gynecomastia tissue was not only possible but also essential to achieve optimal cosmetic results. The layered closure technique is a useful adjunctive treatment after gynecomastia total tissue removal.
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Affiliation(s)
- Robert C Caridi
- Austin Gynecomastia Center, Westlake Plastic Surgery, Austin, Tex
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Innocenti A, Melita D, Dreassi E. Incidence of Complications for Different Approaches in Gynecomastia Correction: A Systematic Review of the Literature. Aesthetic Plast Surg 2022; 46:1025-1041. [PMID: 35138423 PMCID: PMC9411245 DOI: 10.1007/s00266-022-02782-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/09/2022] [Indexed: 11/12/2022]
Abstract
Background Gynecomastia is nowadays a very common disease, affecting a large cohort of patients with different ages. The aim of this literature review is to assess the incidence of complications with all proposed techniques and for combined procedures versus single approach procedures in gynecomastia correction. Materials and Methods A systematic review of the literature was performed to identify all reported techniques for gynecomastia correction covering a period from January 1, 1987 to November 1, 2020. For all selected papers, demographic data, proposed technique, and complications’ incidence have been recorded. Results A total number of 3970 results was obtained from database analysis. A final total number of 94 articles was obtained for 7294 patients analyzed. Patients have been divided into three groups: aspiration techniques, consisting in 874 patients (11,98%), surgical excision techniques, consisting in 2764 patients (37,90%), and combined techniques, consisting in 3656 patients (50,12%). Complications have been recorded for all groups, for a total number of 1407, of which 130 among “Aspiration techniques” group (14,87%), 847 among “Surgical excision techniques” group (30,64%), and 430 in “Combined techniques” group (11,76%). Conclusions Several techniques have been proposed in the literature to address gynecomastia, with the potential to greatly improve self-confidence and overall appearance of affected patients. The combined use of surgical excision and aspiration techniques seems to reduce the rate of complications compared to surgical excision alone, but the lack of unique classification and the presence of several surgical techniques still represents a bias in the literature review. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Adhikari S. Minimal Incision Technique for Gynecomastia. J Cutan Aesthet Surg 2021; 14:344-350. [PMID: 34908778 PMCID: PMC8611696 DOI: 10.4103/jcas.jcas_96_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Gynecomastia or enlargement of the male breasts affects a large proportion of males, with most patients requiring surgical intervention as only a few lesions are actually resolved with medical management alone. Surgery cures the patients of their problems, albeit, at the cost of scarring and other cosmetic problems in some patients. Therefore, refinements in the surgical process are still ongoing so as to provide the best results with minimal scarring. Aims and Objectives: To find out the feasibility of a minimal incision technique for glandular excision after liposuction in patients with gynecomastia so as to decrease the final visible scars in these patients. Materials and Methods: From July 2018 to September 2018, eight patients were subjected to gynecomastia surgery employing liposuction and gland removal through a single transverse 5–7 mm incision in the nipple. All the patients subjected to this technique had Grade IIa gynecomastia as per Simon’s scale. The Global Aesthetic Improvement Scale, comprising a 5-point Likert scale, was employed to find out the satisfaction level of the patients 12 months after surgery; this level was compared with that of a similar population of patients being operated on by employing liposuction and subcutaneous mastectomy by the periareolar technique. Results: The mean operating time was 110 min, and there was minimal bleeding during the procedure. Complications were also negligible, and all patients achieved an excellent chest contour with restoration of protective nipple sensation when evaluated 12 months after surgery. The difference in mean between the 2 patient groups was 0.125 with a p-value of 0.64. Conclusions: Glandular excision through a single transverse incision made through the nipple is a safe approach in selected patients and it produces excellent cosmetic outcomes. However, it requires patience on the part of the surgeon to achieve the desired goals of the surgery.
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Affiliation(s)
- Souvik Adhikari
- Department of Plastic Surgery, IPGME&R and SSKM Hospital, Kolkata, India
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Zocchi ML, Vindigni V. Invited Discussion on: The Nipple-Areolar Complex Over Time After Treatment of Gynecomastia with Ultrasound-Assisted Liposuction Mastectomy Compared to Subcutaneous Mastectomy Alone. Aesthetic Plast Surg 2021; 45:438-441. [PMID: 33403419 DOI: 10.1007/s00266-020-02060-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michele L Zocchi
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35100, Padova, Italy.
- C.S.M. Institute for Regenerative Surgery, Turin, Italy.
| | - Vincenzo Vindigni
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35100, Padova, Italy
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The Vacuum-Assisted Breast Biopsy System is an Effective Strategy for the Treatment of Gynecomastia. Aesthetic Plast Surg 2021; 45:404-410. [PMID: 32886161 DOI: 10.1007/s00266-020-01931-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gynecomastia is the most common benign disease in males with an increasing prevalence in recent years. It may cause local pain and psychological disorders. The vacuum-assisted breast biopsy system has been reported to be a novel surgical approach for the treatment of gynecomastia. However, there are little detailed reports comparing the curative effect between traditional surgery and vacuum-assisted breast biopsy for gynecomastia. Besides, there was little study which compared the application of two different systems for the treatment of gynecomastia. Our study aimed to investigate the effectiveness of vacuum-assisted breast biopsy systems for patients with gynecomastia. METHODS We retrospectively reviewed 83 patients with gynecomastia between January 2015 and December 2019. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. The characteristics of patients as well as the curative effects between the two groups were analyzed. The two vacuum-assisted breast biopsy systems (Mammotome and Encor) were performed for the patients with gynecomastia. The efficacy, safety, complications, and patient satisfactions were recorded during postoperative follow-up periods. RESULTS Compared with the open surgery group, the vacuum-assisted breast biopsy group had significantly smaller scar sizes left after the operation (5.5 ± 1.3 cm vs 0.8 ± 0.2 cm, p < 0.001), and shorter hospital stay time (5.5 ± 2.4 ds vs 3.1 ± 1.6 ds, p < 0.001). Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. There were no statistically significant differences between the two vacuum-assisted breast biopsy systems according to the mean age, the mean operation time, sites, or grade. In addition, no serious complications were observed in vacuum-assisted breast biopsy group. All the patients recovered well and were satisfied with the cosmetic outcomes. CONCLUSION The vacuum-assisted breast biopsy system can be used as a feasible and minimally invasive approach for the treatment of gynecomastia. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Mohamad Hasan R. Modified Benelli procedure for subcutaneous mastectomy in gynecomastia: A randomised controlled trial. Ann Med Surg (Lond) 2019; 47:19-23. [PMID: 31641496 PMCID: PMC6796571 DOI: 10.1016/j.amsu.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 09/06/2019] [Accepted: 09/15/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Gynecomastia is defined as a benign glandular proliferation of the male breast tissue causing enlargement of the breast and a feminine appearance. Gynecomastia is usually treated surgically in some patients by different techniques. AIM OF THE STUDY is to allow ample excess during excision and to remove excess skin to allow for better cosmetic results using "modified Benelli technique" and to obtain good breast shape with better nipple areola complex position without any breast tension. TYPE OF THE STUDY Randomised controlled trial study. PATIENTS AND METHODS The study included 150 patients with gynecomastia (Grade II and III) for the period between January 2010 and January 2016 who attended private hospitals and Al-Kindy Teaching Hospital. The patients were divided into two groups according to the operative techniques used. Group A included 75 patients treated surgically with subcutaneous mastectomy using periareolar incision. Group B; included the other 75 patients who were managed by "modified Benelli technique". RESULTS The subcutaneous mastectomy using "modified Benelli technique" showed a significantly lower operating time due to ample access for excision of breast tissue. Excision of excess skin allowed the areola to retain a cosmetically more acceptable position. There was a lot of pleating of the skin compared to the other technique using the periareolar incision. CONCLUSIONS This technique namely the "modified Benilli technique" provides a relatively simple method with an aesthetically good outcome to treat gynecomastia with a low rate of complications and recurrences.
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Defining the Aesthetic Units of the Male Chest and How They Relate to Gynecomastia Based on 635 Patients. Plast Reconstr Surg 2019; 144:147e-148e. [PMID: 31246853 DOI: 10.1097/prs.0000000000005737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Abstract
Gynecomastia is defined as a unilateral or bilateral persistent benign mammary gland enlargement in men. Prevalence of asymptomatic gynecomastia is up to 65%. True gynecomastia must be distinguished from pseudogynecomastia. Typically, in true gynecomastia, a solid tissue mass is palpable below the nipple-areolar complex. Malignant changes such as male mammary carcinoma must always be ruled out. The causes of gynecomastia are diverse. An imbalance of female to male hormones triggers the onset of the disease. This imbalance can be caused by endogenous diseases like hyperthyroidism, chronic liver disease, primary or secondary gonadal failure, androgen resistance syndromes, medication, and drug abuse. A series of heart or hypertension medications can also trigger gynecomastia. A basic requirement of proper therapy planning is knowledge of the triggers and possible drug therapy options. Inquiring about the patient's lifestyle and medication history is essential. Drug therapy with tamoxifen may be considered at an early stage. For gynecomastia persisting over 12 months, surgical excision is the treatment of choice, and there are several surgical options available depending on the grade of the gynecomastia. A thoughtful approach to managing this condition can lead to high patient satisfaction.
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Affiliation(s)
- Kristin Baumann
- Clinic for Gynecology and Obstetrics, University Medical Centre Schleswig-Holstein Campus Lübeck, Lübeck, Germany
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Laser-assisted Lipolysis Burn Safety: Proposed Detailed Parameters with Assessment of Their Efficacy and Safety. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1934. [PMID: 30534493 PMCID: PMC6250476 DOI: 10.1097/gox.0000000000001934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 07/18/2018] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Many recent studies have evaluated the clinical safety and efficacy of therapeutic lasers in laser lipolysis, but without detailed description of the safe and effective parameters. Purpose: To propose a method for adjusting safe and effective parameters for laser lipolysis. Methods: Detailed calculations of the safe and effective laser parameters for fat melting are proposed in the study. Amount of energy delivered in joules was calculated based on data from Havenith research. External skin and internal tissues temperatures during the procedure were kept in a recommended range and monitored for safety and efficacy. Prospective statistical study was designed on a series of 300 patients who underwent laser-assisted lipolysis and /or liposuction using 2 different machine manufacturers, delivering 1,064/1,320 nm. Results: All areas submitted to laser-assisted liposuction in this series have resulted in no clinical thermal burns injury to the skin. There was improvement in the bulk of fats, skin tightening, skin textures, and cellulites. Conclusion: This study is proposing a simple method for calculations of safe and effective laser lipolysis. Skin burn injury could be highly prevented by following up the proposed detailed basic parameters for laser lipolysis treatment.
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Evaluation of Glandular Liposculpture as a Single Treatment for Grades I and II Gynaecomastia. Aesthetic Plast Surg 2018; 42:1222-1230. [PMID: 29549405 PMCID: PMC6153645 DOI: 10.1007/s00266-018-1118-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/04/2018] [Indexed: 10/24/2022]
Abstract
BACKGROUND Gynaecomastia is a benign enlargement of the male breast, of which the psychological burden on the patient can be considerable, with the increased risk of disorders such as depression, anxiety, and social phobia. Minimal scarring can be achieved by liposuction alone, though it is known to have a limited effect on the dense glandular and fibroconnective tissues. We know of few studies published on "liposuction alone", so we designed this study to evaluate the outcome of combining liposuction with glandular liposculpturing through two axillary incisions as a single treatment for the management of grades I and II gynaecomastia. METHODS We made a retrospective analysis of 18 patients with grade I or II gynaecomastia who were operated on by combined liposuction and glandular liposculpturing using a fat disruptor cannula, without glandular excision, during the period 2014-2016. Patient satisfaction was assessed using the Breast Evaluation Questionnaire (BEQ), which is a 5-point Likert scale (1 = very dissatisfied; 2 = dissatisfied; 3 = neither; 4 = satisfied; 5 = very satisfied). The post-operative aesthetic appearance of the chest was evaluated by five independent observers on a scale from 1 to 5 (5 = considerable improvement). RESULTS The patient mean (SD) overall satisfaction score was 4.7 (0.7), in which 92% of the responders were "satisfied" to "very satisfied". The mean (SD) BEQ for all questions answered increased from 2.1 (0.2) "dissatisfied" preoperatively to 4.1 (0.2) "satisfied" post-operatively. The observers' mean (SD) rate for the improvement in the shape of the front chest wall was 4.1 (0.7). No haematomas were recorded, one patient developed a wound infection, and two patients complained of remnants of tissue. The median (IQR) body mass index was 27.4 (26.7-29.4), 11 patients had gynaecomastia grade I, and 7 patients grade II. The median (IQR) volume of aspirated fat was 700 ml (650-800), operating time was 67 (65-75) minutes, 14 patients had general anaesthesia, and hospital charges were US$ 538 (481-594). CONCLUSIONS Combined liposuction and liposculpturing using the fat disruptor cannula resulted in satisfied patients and acceptable outcomes according to the observers' ratings. It could be a useful alternative with an outcome that corresponds to that of more expensive methods. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Fentiman IS. Managing Male Mammary Maladies. Eur J Breast Health 2018; 14:5-9. [PMID: 29322112 DOI: 10.5152/ejbh.2017.3841] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/30/2017] [Indexed: 11/22/2022]
Abstract
This review examines the symptoms, need for referral and management of the benign breast conditions which afflict males, together with the steps that are necessary to exclude or confirm male breast cancer. The most common complaint is gynaecomastia, either true or pseudo, and the majority of these cases need reassurance without over-investigation. Drugs that induce breast enlargement are described in order that, when possible, a medication switch can be made. Men receiving endocrine therapy for prostate cancer may develop painful gynaecomastia and this can be relieved with tamoxifen. All men with breast cancer need mammography as part of their work-up but this should not be used as a screening technique for symptomatic males. Because of lack of lobular development, both cysts and fibroadenomas are very rare in men; but those with nipple discharge need referral and investigation as some will have underlying malignancy.
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Affiliation(s)
- Ian S Fentiman
- Department of Research Oncology, Guy's Hospital, London, England
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Özalp B, Berköz Ö, Aydınol M. Is the transposition of the nipple-areolar complex necessary in Simon grade 2b gynecomastia operations using suction-assisted liposuction? J Plast Surg Hand Surg 2017; 52:7-13. [PMID: 28471290 DOI: 10.1080/2000656x.2017.1313260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the efficacy of suction-assisted liposuction (SAL) in Simon grade 2b gynecomastia and its effect on sternal notch to nipple areola (SNN) distance. METHODS A retrospective analysis was performed on 21 patients with grade 2b gynecomastia who underwent SAL. Preoperative and postoperative SNN distances of the patients were measured, the results were analysed using a Mann-Whitney U test and a p-value <.05 was accepted as statistically significant. Aesthetic results were evaluated by the surgical team considering five criteria: breast size, breast shape, nipple-areolar complex positioning, scarring, and skin tightness of the breast envelope. A 10-point Likert scale was used to assess patient satisfaction with SAL surgery. RESULTS All of the patients were followed up for an average period of 17.8 months (range = 12-28 months). The mean amount of lipoaspirate was 232 mL per breast (range = 190-310 mL). The mean preoperative SNN distance was 22.3 cm (range = 20-23.5 cm), whereas postoperative was 21.3 cm (range = 19.2-22.8 cm); the difference was statistically significant (p < .05). There was one case of nipple areola necrosis, three hypoesthesia, five persistent pains, and four slight buttonhole deformities. The aesthetic result was evaluated as very good by the surgical team, and the overall patient satisfaction rate in terms of breast shape and volume was 92%. CONCLUSIONS It was concluded that SAL provides a good aesthetic outcome in patients with Simon grade 2b gynecomastia and shortens the SNN distance by 1 cm, but further clinical studies are required to support this conclusion.
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Affiliation(s)
- Burhan Özalp
- a Department of Plastic, Reconstructive and Aesthetic Surgery, Dicle Medical Faculty , Dicle University , Diyarbakır , Turkey
| | - Ömer Berköz
- b Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul Medical Faculty , Istanbul University , Istanbul , Turkey
| | - Mustafa Aydınol
- a Department of Plastic, Reconstructive and Aesthetic Surgery, Dicle Medical Faculty , Dicle University , Diyarbakır , Turkey
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