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Gynecomastia is a benign proliferation of male breast glandular tissue. Gynecomastia can affect men at any stage of life. Traditional treatment options involved excisional surgeries with periareolar or T-shaped scars, which can leave more visible scars on the chest. The technique presented represents a technique used by the senior author, which rel...
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BACKGROUND
Surgery, as the main approach in higher stages of gynecomastia, has different techniques regarding the staging of the disease. The more the grade of gynecomastia, the more complicated the used surgical techniques, conventionally. This study assessed the success rate of the simplest surgical technique in higher grades of gynecology as wel...
Citations
... Historically, subcutaneous mastectomy was the standard approach; however, application of tools such as the arthroscopic shaver has become more popular due to its effectiveness in breaking up fibroconnective tissue and dense parenchymal tissue. 9 More recently, surgeons have found success in a technique that combines utilization of both ultrasoundassisted liposuction and the arthroscopic shaver to provide a coordinated removal of fatty and fibrous glandular tissue. Compared with traditional techniques, this minimally invasive technique has been found to improve outcomes with less scarring while effectively removing fibrofatty and glandular tissue. ...
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.
... More extensive surgery, including skin resection, is required for patients with marked gynecomastia and those who develop excessive sagging of the breast tissue (with weight loss). Liposuction alone may be sufficient, if breast enlargement is purely due to excess fatty tissue without substantial glandular hypertrophy [6] . ...
... Table (5) shows that there is no significant difference between the 2 interventions as regards scar quality. Table (6) shows that there is no significant difference between the 2 interventions as regards patients' satisfaction. ...
... Gynecomastia is a prevalent male breast glandular tissue benign proliferation that affects 90% of neonates, 60% of boys in the adolescence period, and about 30 to 70% of men as a transient condition in the adulthood period, with higher incidence among older men, especially those with medical illness (Bailey et al. 2016;Longheu 2016). Some cases are treated medically; however, others require surgical resection, which provides better cosmetic improvement and might be necessary if carcinoma is suspected. ...
... Some cases are treated medically; however, others require surgical resection, which provides better cosmetic improvement and might be necessary if carcinoma is suspected. Surgical treatment of gynecomastia includes either liposuction, gland excision, or both (Bailey et al. 2016;Sollie 2018). ...
Background
Nerve block reduces anesthetics requirement, allows faster recovery, and reduces postoperative pain. The modified pectoral plane block (PECS II) and the erector spinae plane block (ESP) have been proposed for nerve block in men undergoing breast surgery for gynecomastia.
This study aimed to compare the efficacy of PECS II and ESP for perioperative analgesia in men undergoing surgical treatment of gynecomastia.
We conducted a randomized clinical trial on 46 males (with ASA I and II, age range from 18 to 25 years) undergoing surgical gynecomastia treatment in a tertiary medical center. Patients were randomly allocated to receive nerve blocks with either PECS II or ESP in addition to the general anesthesia. The postoperative opioid requirement, analgesic doses, pain intensity on the VAS score, hemodynamic parameters throughout the operation, and complications were recorded and compared for both groups.
Results
PECS II group had more favorable outcomes compared to the ESP group, evident by the significantly less total morphine consumption in 24 h (6.09 vs. 14.26 mg, P ≤ 0.001) and the significantly higher effective analgesic time (6.57 vs. 4.91 h, P ≤ 0.001). In addition, there were no intraoperative or postoperative complications recorded in both groups.
Conclusions
For men undergoing elective surgical treatment of gynecomastia, the ultrasound-guided modified PECS II is superior to the ESP in terms of opioid requirement, analgesic doses, and pain intensity.
... Recently, there have been reports of combining UAL and surgical excision of the gland within the same setting [19]. ...
... 15-17 4. Liposuction and direct gland excision is performed first and after several months, few patients will require a second operation to excise the significant skin redundancy. 10,18 Here the authors propose a novel, simple, cost-effective, single-step technique called the NAC plaster lifting technique, to address the skin redundancy in severe gynecomastia with liposuction, direct gland excision with pull through technique as an alternative to the above-mentioned procedures. This simple reproducible technique does not produce a visible scar and proved to be beneficial to the patient. ...
... Similar techniques, as described by Botta, recognize nipple-areolar complex (NAC) viability on the subdermal plexus alone and utilize superiorly based dermo-glandular flaps, allowing for a more uniform excision of breast tissue. 18,20 The most common complication encountered is hypertrophic scar due to excessive resection and too much tension on the circumareolar suture line. Longhue et al in their study reported that 27.5% patients were not satisfied because of hypertrophic scar or breast asymmetry. ...
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.
... 2,[8][9][10] The subsequent use of UAL in the treatment of gynecomastia resulted in further refinement. [11][12][13] Third generation UAL was used on all patients in this study. Improved outcomes, growth in the experience of surgeons, and availability of internet resources have led, in turn, to greater patient expectations and concerns regarding the procedural results. ...
... UAL is more effective in the treatment of dense, gynecomastia tissue than suction-assisted lipoplasty. 11,12,21 UAL is ineffective in the removal of dense fibroglandular tissue beneath the NAC, which requires surgical removal. 12,22 UAL treatment of gynecomastia tissue provides effective hemostasis, reduces surgeon fatigue, enhances tissue shrinkage, and facilitates separation of gynecomastia tissue from normal tissue, expediting subsequent mass removal. ...
... 11,12,21 UAL is ineffective in the removal of dense fibroglandular tissue beneath the NAC, which requires surgical removal. 12,22 UAL treatment of gynecomastia tissue provides effective hemostasis, reduces surgeon fatigue, enhances tissue shrinkage, and facilitates separation of gynecomastia tissue from normal tissue, expediting subsequent mass removal. Furthermore, the use of electrosurgery, special instruments, or retractors is not necessary. ...
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.
... It is generally responsible for significant psychological repercussions. The diagnosis of gynecomastia will first allow to distinguish between real gynecomastia and pseudo gynecomastia which corresponds to a benign increase in the volume of the breast in men secondary to an adipose deposit also called: adipomastia [3], [4]. ...
... There are different etiologies that can cause gynecomastia [1]- [4], [9]. ...
... o Dense forms where a mastectomy must be performed immediately. The management of gynecomastia can be based on medical treatment [1], [4], when an etiology is identified, or on surgical treatment which can be radical or conservative. ...
Gynecomastia is a benign unilateral or bilateral increase in glandular tissue in men with significant aesthetic and psychological repercussions. In some situations, it might be a symptom of an underlying condition. The management of gynecomastia is mainly based on an extensive etiological analysis made of an exhaustive endocrine assessment, and a radical or conservative adapted treatment allowing to obtain the best aesthetic result. Through literature review some clinical cases, we establish different etiological, clinical aspects and management of gynecomastia.
... Successful contouring for gynecomastia surgery required removal of glandular component, adipose tissue and excess skin. 3 To enhance the masculine contour of male chest and get rid of gynecomastia, selective liposuction and fat grafting to the pectoralis major may be considered. 4 Aim of the present work was to assess high definition liposculpture to get masculinized appearance of the chest for treatment of early grades gynecomastia ...
... Furthermore, the alteration of the subdermal layer with ultrasound will lead to a sufficient postoperative skin retraction [26]. In support of this, Bailey et al. changed their approach as well when using mainly UAL combined with a pull through technique of the residual tissue with success even with higher amounts of skin excess [27]. In contrast to our study histological examination was not done in those cases. ...
Background
Many techniques for the surgical treatment of gynaecomastia have been reported to be effective with reasonable limited scar formation. The aim of this study was to develop a grade adopted algorithm for effective and scar sparing techniques in reconstruction of the male breast dependent on aetiology and grading.Methods
Operative techniques, results, rates of revisions and complications were recorded between 2006 and 2018 and results of 164 male patients were analysed, retrospectively. Skin resecting methods have been used in the earlier stage but were later replaced by minimal periareolar incisions and subcutaneous mastectomy. Resections were combined with ultrasound-assisted liposuction up to grade 2b and inferior pedicled breast reduction in 3rd degree gynaecomastias resulting in reduction of scars and effective removal of breast tissue.ResultsRetrospective analysis showed that a periareolar mastopexy was used in 24% of patients with gynaecomastia grade I, IIa and IIb to reshape the breast after subcutaneous mastectomy in the early stage of this study from 2006 to 2010. With the established standardised use of ultrasound-assisted liposuction, only 2% of patients required a mastopexy in the following years. In grade 3 gynaecomastia, the classical approach resulting in an inverted t-scar was later abandoned for an approach with a periareolar and submammary scar and inferior dermoglandular flap. The rate of secondary surgery with the used techniques did not increase.Conclusions
When using standardised techniques in reshaping the male breast, an aesthetically pleasing and safe result can be achieved by scar sparing techniques in a safe single-stage procedure.Level of evidence Level IV, therapeutic study.
... Derangement of hormonal balance in favor of estrogen may cause physiological or pathological gynecomastia (4,6). Common gynecomastia causes are listed in Table 1 (3,5,9). There are six different types of grading systems for gynecomastia. ...
... There are six different types of grading systems for gynecomastia. In Table 2, the three most commonly preferred grading systems -Cordova-Moschella, Rochrich, Simon-are listed (9)(10)(11). In our clinic, we prefer to use the Simon Classification as it is simple and practical (Table 2). ...
... Surgical treatment modalities are classified as liposuction or excisional methods chosen on patient characteristics (12). The effective results of these various treatment modalities in different patient groups are well documented in the literature (9,(13)(14)(15). In this study, we present the results of our treatment method as liposuction using varying thickness cannulas in different tissue planes alone or with short scar excision in Simon Grade I, II and III patients ( Figure 1). ...
Amaç: Jinekomasti fizyolojik, patolojik veya ilaca bağlı nedenlerle erkeklerdeki normal meme dokusunun görünür hale gelecek kadar büyümesidir. Fizyolojik ve patolojik jinekomasti östrojen ile androjen metabolizmasındaki bozulmadan dolayı ortaya çıkmaktadır. İlaca bağlı jinekomasti ise yine bu hormonal metabolizmayı etkileyen hormonlar dışında farklı ilaç gruplarında da yan etki olarak görülebilmektedir. Jinekomasti tedavisinde özellikle erken dönemde medikal tedavi ve neden olabilecek ilaçların kesilmesi, daha ileri dönemlerde ise direkt eksizyon, endoskopik subkutan mastektomi, liposuction yöntemleri ile eksizyon gibi çeşitli yöntemlerle başarılı sonuçlar bildirilmiştir.Gereç ve Yöntemler: Bu çalışmada Evre I, II ve III hastalarda 3 farklı planda 3 farklı kalınlıkta kanüller ile aspirasyon destekli ıslak liposuction (suction assisted wet liposuction) tekniği ile jinekomasti tedavi sonuçlarımızı sunmaktayız. Bu teknik ile kliniğimizde 2009 ile 2019 arasında 45 hasta opere edilmiştir. Tüm hastalar operasyon sonrasında komplikasyon oranlarının ve nihai estetik sonucun gözlemlenebilmesi için postoperatif dönemde en az 6 ay takip edilmiştir.Bulgular: Bu çalışmada değerlendirilen 45 hastada komplikasyon oranı %6,7, operasyon başarı oranı %93,3 ve hasta memnuniyeti %91,1 idi. Jinekomasti tedavisinde başta liposuction olmak üzere diğer mevcut tedaviler gözden geçirilmiş ve çalışmamızdaki sonuçlar literatür eşliğinde değerlendirilmiştir.Sonuç: Jinekomastinin cerrahi tedavisinde mevcut çok sayıda farklı yöntem bulunmaktadır. Bu çalışmada ıslak liposuction yöntemi ile jinekomasti tedavisinde Evre I, II ve III hasta grubunda başarılı sonuçlar elde edildiği ve hasta memnuniyetinin yüksek olduğu gösterilmiştir
