Incidence of Complications for Different Approaches in Gynecomastia Correction: A Systematic Review of the Literature

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.

[Current status and prospects of clinical application of liposuction]

OBJECTIVE

To review the characteristics and deficiencies of various liposuction methods to provide reference for choosing more suitable liposuction in clinic and ideas for the improvement and development of liposuction equipment.

METHODS

The literature related to liposuction in recent years was consulted, and the principle, indications as well as existing problems were reviewed.

RESULTS

Liposuction can be divided into two categories according to the principles of fat separation. The first type relies on physical cutting to separate fat, including suction-assisted liposuction (SAL), power-assisted liposuction (PAL), and water-assisted liposuction (WAL). SAL and PAL are simple to operate and low in price, but the effect of liposuction mainly depends on the experience of the surgeon, and complications such as uneven appearance, hematoma, and ecchymosis may occur. WAL saves time and effort, but has lower cost performance. The second type relies on energy destruction to separate fat, including ultrasound-assisted liposuction, laser-assisted liposuction, and radiofrequency-assisted liposuction. This type of surgery has the advantages of less trauma, fast postoperative recovery, and skin tightening. However, the equipment is more expensive, and has a risk of skin burns.

CONCLUSION

Liposuction can effectively reduce local fat accumulation, but it still has limitations. Equipment improvement and fat transplantation are important directions for liposuction's future development.

Preclinical evaluation for removal of bulging lower eyelid fat using ultrasound-assisted lipolysis on a Yorkshire pig

PURPOSE

The purpose of this study is to evaluate the efficacy and safety of treating lower eyelid fat bulging with ultrasound-assisted lipolysis (UAL) by performing a preclinical evaluation of the procedure on a Yorkshire pig.

METHODS

Two white Yorkshire pigs had lower eyelid fat bulging treated with UAL using a probe with a diameter of 1.0 mm or less. Fourteen days after treatment, we evaluated the changes in fat thickness from ultrasound, changes in skin contour (volume and height) from the Antera 3D™, and the disruption of fat cells and changes in collagen synthesis from histological evaluation.

RESULTS

Fourteen days after treatment, the fat layer was significantly reduced with no damage to the skin surface. The mean change in the subcutaneous fat layer thickness was decreased 1.51-0.75 mm in ultrasound analysis. The skin contour of the treated area also decreased with time from 202.5 to 163.5 mm in mean volume and 0.8111 to 0.646 mm in mean height. Masson's trichrome staining showed that the UAL treatment induced the regeneration and remodeling of collagen.

CONCLUSION

The results of this study demonstrate that UAL successfully reduced the bulging lower eyelid fat of a Yorkshire pig and also increased collagen contraction to tighten skin. UAL may be a beneficial and well-tolerated treatment option for lower eyelid fat bulging.

Orange Peel Excision of Gland: A Novel Surgical Technique for Treatment of Gynecomastia

INTRODUCTION

Gynecomastia is a common aesthetic problem faced by men with reported incidence as high as 65% with serious psychosocial impact. Although various techniques of liposculpture combined with glandular excision is the standard of treatment, many of the glandular excision techniques have inherent limitations and complications such as leaving a long scar, long operative time, contour abnormalities, and increased risk of hematoma. Here, we describe an innovative "the orange peel excision of gland (OPEG) technique" which overcomes these limitations with excellent cosmetic results.

METHODS

A total of 38 breasts were operated in 20 patients (18 bilateral and 2 unilateral). All the patients underwent suction-assisted liposuction and glandular excision under general anesthesia by our OPEG technique.

RESULTS

The average operative time per breast was 60 minutes. One patient had a small hematoma which did not require evacuation. The patient satisfaction rate was 95%.

CONCLUSION

The technique has reduced operative time and avoids residual gland and hematoma with excellent aesthetic outcome.