Liposuction Assisted De-Epithelialization Pull-Through Technique for Management of Grade IIB and III Gynecomastia | ||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||
| Article 10, Volume 48, Issue 2, April 2024, Pages 155-161 PDF (752.09 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejprs.2024.352139 | ||
| Authors | ||
| Rowan Almoddather Elhadidy* 1; Ahmed Abdelmonem Ibrahim2; Omar Osama Shouman1; Ahmed Abdelfattah Elsherifa1 | ||
| 1The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Mansoura University | ||
| 2The Department of General Surgery, Faculty of Medicine, Mansoura University | ||
| Abstract | ||
| Background: Gynecomastia is an abnormal and benign enlargement of male breast tissue. It occurs as a result of an imbalance between estrogen and androgen levels that may be due to a physiological or pathological cause. Multiple surgical approaches have been recommended to manage this problem. It is widely accepted that liposuction solely or when combined with subcutaneous mastectomy is effective for the management of low to intermediate grades of gynecomastia. However, liposuction along with subcutaneous mastectomy gives unsatisfactory results in high grades where there is excess redundant skin that needs excision. Several skin incisions have been mentioned in literature for excision of excess skin, however, some of these are accompanied by unaesthetic scars. Objective: To assess the outcome of surgical correction of high grades of gynecomastia in a single-stage procedure. Patients and Methods: We conducted a prospective analysis on 20 patients with grades IIb or III gynecomastia who underwent single-stage procedures. Photographs were clinically evaluated by two independent surgeons with respect to chest contour, symmetry, scar, and residual ptosis. Patient satisfaction was surveyed regarding chest contour and scar appearance. Results: Statistical analysis revealed a significant improvement in patient’s clinical measurements after operation, good doctor’s scoring and patient satisfaction scoring among studied cases, and accepted complication rates. Conclusions: The current approach eliminates the need for skin resection in a second surgery, permits immediate skin recontouring, and achieves an acceptable aesthetic scar. | ||
| Keywords | ||
| Gynecomastia; Circum-areolar incision; Gland excision; Grades IIB and III; Scar | ||
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| References | ||
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Cavina C.: Gynecomastia. InInternational Textbook of Aesthetic Surgery (pp. 285-294). Berlin, Heidelberg: Springer Berlin Heidelberg, 2016. 2- Morselli P.G. and Morellini A.: Breast reshaping in gynecomastia by the “pull-through technique”: considerations after 15 years. European Journal of Plastic Surgery, May 35: 365-71, 2012. 3- Persichetti P., Berloco M., Casadei R.M., Marangi G.F., Di Lella F. and Nobili A.M.: Gynecomastia and the complete circumareolar approach in the surgical management of skin redundancy. Plastic and Reconstructive Surgery, Apr. 1; 107 (4): 948-54, 2001. 4- Webster J.P.: Mastectomy for gynecomastia through a semicircular intra-areolar incision. Annals of Surgery, Sep. 124 (3): 557, 1946. 5- Kasielska A. and Antoszewski B.: Surgical management of gynecomastia: An outcome analysis. Annals of Plastic Surgery, Nov. 1; 71 (5): 471-5, 2013. 6- Tashkandi M., Al-Qattan M.M., Hassanain J.M., Hawary M.B. and Sultan M.: The surgical management of highgrade gynecomastia. Annals of Plastic Surgery, Jul. 1; 53 (1): 17-20, 2004. 7- Ibrahiem SM.: Severe gynecomastia: New technique using superior pedicle NAC flap through a circumareolar approach. Annals of Plastic Surgery, Jun. 1; 76 (6): 645-51, 2016. 8- Fikry A. and Nasr M.: Surgical management of high grade gynecomastia: Combination of liposuction, glandular resection and a circumareolar skin reduction. The Egyptian Journal of Plastic and Reconstructive Surgery, Jul. 1; 42 (2): 323-9, 2020. 9- Li C.C., Fu J.P., Chang S.C., Chen T.M. and Chen S.G.: Surgical treatment of gynecomastia: Complications and outcomes. Annals of Plastic Surgery, Nov. 1; 69 (5): 510- 5, 2012. 10- Swerdloff R.S. and Ng J.C.: Gynecomastia: Etiology, diagnosis, and treatment. Endotext [Internet]. Jan 6, 2023. 11- Hurwitz D.J. and Davila A.A.: Contemporary management of gynecomastia. Clinics in Plastic Surgery, Apr. 1; 49 (2): 293-305, 2022. 12- Cordova A. and Moschella F.: Algorithm for clinical evaluation and surgical treatment of gynaecomastia. Journal of plastic, reconstructive & aesthetic surgery, Jan. 1; 61 (1): 41-9, 2008. 13- Diyarbakirlioglu M., Ercan A. and Dogan Y.: Correction of high-grade pseudogynecomastia after massive weight loss: Modified inferior dermoglandular pedicled transverse scar reduction. Aesthetic Plastic Surgery, Apr. 44: 435-41, 2020. 14- Cannistra C., Piedimonte A. and Albonico F.: Surgical treatment of gynecomastia with severe ptosis: Periareolar incision and dermal double areolar pedicle technique. Aesthetic Plastic Surgery, Nov. 33: 834-7, 2009. 15- Botta S.A.: Alternatives for the surgical correction of severe gynecomastia. Aesthetic Plastic Surgery, Jan. 22: 65- 70, 1998. 16- Beckenstein M.S., Windle B.H. and Stroup Jr. R.T.: Anatomical parameters for nipple position and areolar diameter in males. Annals of Plastic Surgery, Jan. 1; 36 (1): 33-6, 1996 | ||
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