Surgical Treatment of Gynaecomastia: A Prospective Study in 75 Patients

Adel M. Tolba^*, Mohamed Nasr

Plastic Surgery Unit, General Surgery, Zagazig University, Zagazig, Egypt.

DOI: 10.4236/ss.2015.611073                

Abstract

Introduction: Gynaecomastia is a benign enlargement of male breast; many techniques have been described for management but none have gained universal acceptance. We discuss the outcomes of the surgical management of gynaecomastia and assess the morbidity and complication rates associated with the procedure to determine whether certain surgical techniques produce better outcomes. Materials and Methods: 75 patients with gynaecomastia were operated in our hospital during the period from Jan. 2009 to Jan. 2015. Results: A total of 140 breasts were operated on during the study period. Patients underwent either liposuction alone (20 breasts), excision alone (70 breasts), both excision and liposuction (36 breast) or skin reduction procedure (14 breasts). 19 operated breasts (13.4%) experienced some form of complications. Minor complications included seroma (4 patients), superficial wound dehiscence (3 patients) and two patients developed haematomas requiring evacuation in theatre. Unsatisfactory cosmotic result was present in 10 breasts and surgical revision was done in 5 breasts. Simon grade 111 breasts experienced the highest complication rate. Conclusion: The study has found that moderate sized gynaecomastia whether true or pseudo gynaecomastia with mild to moderate breast redundancy can be managed easily and effectively by liposuction alone or combined with glandular resection while the conventional infraareolar subcutaneous mastectomy still gives satisfactory results and with no need to remove extra skin. On the other hand, large gynaecomastia with severe breast redundancy can be treated effectively by the inferior pedicle technique without vertical scar.

Keywords

Gynaecomastia, Male Breast, Surgical Management

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Yavuz, M., Kesiktas, E., Kesiktas, N.N. and Acartürk, S. (2006) Lighted Retractor-Assisted Transaxillary Approach in Gynecomastia Correction. Annals of Plastic Surgery, 57, 370-373. http://dx.doi.org/10.1097/01.sap.0000222567.04635.3b
[2]	Bembo, S.A. and Carlson, H.E. (2004) Gynecomastia: Its Features, and When and How to Treat It. Cleveland Clinic Journal of Medicine, 71, 511-517.
[3]	Kornstein, A.N. and Cinelli, P.B. (1992) Inferior Pedicle Reduction Technique for Larger Forms of Gynecomastia. Aesthetic Plastic Surgery, 16, 331-335.
[4]	Riefkohl, R. and Courtiss, E.H. (1992) Gynecomastia. In: Georgiade, N.G., Georgiade, G.S. and Riefkohl, R., Eds., Textbook of Plastic Maxillofacial and Reconstructive Surgery, Vol 2, 2nd Edition, Williams &Wilkins, Baltimore, 877-882.
[5]	Colombo-Benkmann, M., Buse, B., Stern, J. and Herfarth, C. (1999) Indications for and Results of Surgical Therapy for Male Gynecomastia. The American Journal of Surgery, 178, 60-63. http://dx.doi.org/10.1016/S0002-9610(99)00108-7
[6]	Cordova, A. and Moschella, F. (2008) Algorithm for Clinical Evaluation and Surgical Treatment of Gynaecomastia. Journal of Plastic, Reconstructive & Aesthetic Surgery, 61, 41-49. http://dx.doi.org/10.1016/j.bjps.2007.09.033
[7]	Hammond, D.C. (2009) Surgical Correction of Gynecomastia. Plastic and Reconstructive Surgery, 124, 61e-68e. http://dx.doi.org/10.1097/PRS.0b013e3181aa2dc7
[8]	Wiesman, I.M., Lehman Jr., J.A., Parker, M.G., Tantri, M.D. and Wagner, D. Sperithelial Incision for the Surgical Treatment of Gynecomastia. Annals of Plastic Surgery, 54, 130-1344.
[9]	Pedersen, J.C. (2004) Gynecomastia: An Outcome Analysis. Annals of Plastic Surgery, 53, 97-101.
[10]	Letterman, G.L. and Schurter, M. (1986) Suggested Nomenclature for Aesthetic and Reconstructive Surgery of the Breast. Part III: Gynaecomastia. Aesthetic Plastic Surgery, 10, 55-57. http://dx.doi.org/10.1007/BF01575270
[11]	Celebioglu, S., Ertas, N.M., Ozdil, K. and Oktem, F. (2004) Gynecomastia Treatment with Subareolar Glandular Pedicle. Aesthetic Plastic Surgery, 28, 281-286. http://dx.doi.org/10.1007/s00266-004-1300-1
[12]	Rohrich, R.J., Ha, R.Y., Kenkel, J.M. and Adams Jr., W.P. (2003) Classification and Management of Gynecomastia: Defining the Role of Ultrasound-Assisted Liposuction. Plastic & Reconstructive Surgery, 111, 909-923. http://dx.doi.org/10.1097/01.PRS.0000042146.40379.25
[13]	Aslan, G., Tuncali, D., Terzioglu, A. and Bingul, F. (2005) Periareolar-Transareolar-Perithelial Incision for the Surgical Treatment of Gynecomastia. Annals of Plastic Surgery, 54, 130-134. http://dx.doi.org/10.1097/01.sap.0000143513.77819.7a
[14]	Braunstein, G.D. (2007) Clinical Practice. Gynecomastia. The New England Journal of Medicine, 357, 1229-1237. http://dx.doi.org/10.1056/NEJMcp070677
[15]	Persichetti, P., Berloco, M., Casadei, R.M., Marangi, G.F., Di Lella, F. and Nobili, A.M. (2001) Gynecomastia and the Complete Circumareolar Approach in the Surgical Management of Skin Redundancy. Plastic & Reconstructive Surgery, 107, 948-954. http://dx.doi.org/10.1097/00006534-200104010-00007
[16]	Botta, S.A. (1998) Alternatives for the Surgical Correction of Severe Gynaecomastia. Aesthetic Plastic Surgery, 22, 65-70. http://dx.doi.org/10.1007/s002669900168
[17]	Rosenberg, G.J. (1987) Gynecomastia: Suction Lipectomy Ascontemporary Solution. Plastic & Reconstructive Surgery, 80, 379-386. http://dx.doi.org/10.1097/00006534-198709000-00007
[18]	Stark, B., Grandel, S. and Spilker, G. (1992) Tissue Suction of the Male and Female Breast. Aesthetic Plastic Surgery, 16, 317-324. http://dx.doi.org/10.1007/BF01570694
[19]	Fruhstorfer, B.H. and Malata, C.M. (2003) A Systematic Approach to the Surgical Treatment of Gynaecomastia. British Journal of Plastic Surgery, 56, 237-246. http://dx.doi.org/10.1016/s0007-1226(03)00111-5
[20]	Noer, H.H., Soe-Nielsen, N.H., Gottlieb, J. and Partoft, S. (1991) Gynecomastia Treated by Subcutaneous Mastectomy Using Webster’s Method. Ugeskrift for Laeger, 153, 578-580.
[21]	Steele, S.R., Martin, M.J. and Place, R.J. (2002) Gynecomastia: Complications of the Subcutaneous Mastectomy. The American Surgeon, 68, 210-213.
[22]	Colonna, M.R., Preis, F.W.B., Ponzielli, G., Cavallini, M., Giovannini, U.M. and Leo, A.D. (1999) Gynecomastia: Diagnosticand Surgical Approach in the Treatment of 61 Patients. Annali Italiani di Chirurgia, 70, 699-702.
[23]	Pitman, G.H. (1993) Breast and Chest Wall. In: Pitman, G.H., Ed., Liposuction and Aesthetic Surgery, Quality Medical Publishing, Inc., St. Louis, 197-215.
[24]	Samdal, F., Kleppe, G. and Aabyholm, F. (1991) A New Suction Assisted Device for Removing Glandular Gynecomastia. Plastic & Reconstructive Surgery, 87, 383-384. http://dx.doi.org/10.1097/00006534-199102000-00039
[25]	Graf, R., Auersvald, A., Damasio, R.C.C., Rippel, R., de Arau, L.R.R., Bigarelli, L.H.C. and Franck, C.L. (2003) Ultrasound-Assisted Liposuction: An Analysis of 348 Cases. Aesthetic Plastic Surgery, 27, 146-153. http://dx.doi.org/10.1007/s00266-002-1516-x
[26]	Coleman, W.P., Letessier, S. and Hanke, C.W. (1997) Liposuction. In: Coleman, W.P., Hanke, C.W., Alt, T.H. and Asken, S., Eds., Cosmetic Surgery of the Skin, Mosby, St. Louis.
[27]	Apfelberg, D.B. (1996) Results of Multicenter Study of Laser-Assisted Liposuction. Clinics in Plastic Surgery, 23, 713-719.
[28]	Mordon, S., Eymard-Maurin, A.F., Wassmer, B. and Ringot, J. (2007) Histologic Evaluation of Laser Lipolysis: Pulsed 1,064-nm ND:YAG Laser versus CW-980 nm Diode Laser. Aesthetic Surgery Journal, 27, 263-268. http://dx.doi.org/10.1016/j.asj.2007.03.005
[29]	Teimourian, B. and Perlman, R. (1983) Surgery for Gynaecomastia. Aesthetic Plastic Surgery, 7, 155-157. http://dx.doi.org/10.1007/BF01571338
[30]	Lewis, C.M. (1985) Lipoplasty: Treatment for Gynaecomastia. Aesthetic Plastic Surgery, 9, 287-292. http://dx.doi.org/10.1007/bf01571048
[31]	Courtiss, E.H. (1987) Gynecomastia: Analysis of 159 Patients and Current Recommendations for Treatment. Plastic & Reconstructive Surgery, 79, 740-750. http://dx.doi.org/10.1097/00006534-198705000-00010
[32]	Gasperoni, C., Salgarello, M. and Gasperoni, P. (2000) Technical Refinements in the Surgical Treatment of Gynaecomastia. Annals of Plastic Surgery, 44, 455-458. http://dx.doi.org/10.1097/00000637-200044040-00020
[33]	Maldick, R.A. (1991) Gynaecomastia: Liposuction and Excision. Clinics in Plastic Surgery, 18, 815-822.
[34]	Boljanovic, S., Axelsson, C.K. and Elberg, J.J. (2003) Surgical Treatment of Gynecomastia: Liposuction Combined with Subcutaneous Mastectomy. Scandinavian Journal of Surgery, 92, 160-162.
[35]	Rigg, B.M. (1991) Morselization Suction: A Modified Technique for Gynecomastia. Plastic & Reconstructive Surgery, 87, 159-160. http://dx.doi.org/10.1097/00006534-199107000-00029
[36]	Abramo, A.C. (1994) Axillary Approach for Gynecomastia Liposuction. Aesthetic Plastic Surgery, 18, 265-268. http://dx.doi.org/10.1007/BF00449792
[37]	Letterman, G. and Schurter, M. (1972) Surgical Correction of Massive Gynecomastia. Plastic & Reconstructive Surgery, 49, 259-262. http://dx.doi.org/10.1097/00006534-197203000-00003
[38]	Brenner, P., Berger, A., Schneider, W. and Axmann, H.-D. (1992) Male Reduction Mammoplasty in Serious Gynecomastias. Aesthetic Plastic Surgery, 16, 325-330. http://dx.doi.org/10.1007/BF01570695
[39]	Wray, R.C., Hoopes, J.E. and Davis, G.M. (1974) Correction of Extreme Gynaecomastia. British Journal of Plastic Surgery, 27, 39-41. http://dx.doi.org/10.1016/0007-1226(74)90060-5
[40]	Davidson, B.A. (1979) Concentric Circle Operation for Massive Gynecomastia to Excise the Redundant Skin. Plastic & Reconstructive Surgery, 63, 350-354. http://dx.doi.org/10.1097/00006534-197903000-00009
[41]	Perischetti, P., Berloco, M., Casadei, R.M., Marangi, G.F., Di Lella, F. and Nobili, A.M. (2001) Gynecomastia and the Complete Circumareolar Approach in the Surgical Management of Skin Redundancy. Plastic & Reconstructive Surgery, 107, 948-954. http://dx.doi.org/10.1097/00006534-200104010-00007
[42]	Huang, T.T., Hidalgo, J.E. and Lewis, S.R. (1982) A Circumareolar Approach in Surgical Management of Gynaecomastia. Plastic & Reconstructive Surgery, 69, 35-40. http://dx.doi.org/10.1097/00006534-198269010-00005
[43]	Simon, B.B., Hoffman, S. and Kahn, S. (1973) Classification and Surgical Correction of Gynecomastia. Plastic & Reconstructive Surgery, 51, 48-52. http://dx.doi.org/10.1097/00006534-197301000-00009
[44]	Davidson, B.A. (1979) Concentric Circle Operation for Massive Gynecomastia to Excise the Redundant Skin. Plastic & Reconstructive Surgery, 63, 350-354. http://dx.doi.org/10.1097/00006534-197903000-00009
[45]	Sarrabayrouse, M., Loustau, H. and Mayer, H.F. (2006) Versatility of the 360° Periareolar Approach for the Treatment of Mammary Pathology. Aesthetic Plastic Surgery, 30, 9-14. http://dx.doi.org/10.1007/s00266-005-0072-6
[46]	Lejour, M. (1994) Vertical Mammaplasty and Liposuction of the Breast. Plastic & Reconstructive Surgery, 94, 100-114. http://dx.doi.org/10.1097/00006534-199407000-00010