A New Classification and Treatment Protocol for Gynecomastia

Abstract

It is not uncommon to encounter patients who have undergone surgery for gynecomastia but who were not fully satisfied with the results. Although various approaches and techniques based on presurgical classification systems aimed at yielding the best possible surgical outcomes have been offered, standardized recommendation that is generally accepted by surgeons is lacking. The author reports on a new classification system and treatment protocol for the surgical treatment of gynecomastia. A system was developed that classifies patients into 3 types based on skin elasticity, presence of an inframammary fold (IMF), and mammary ptosis. Surgical excision of the breast mass was followed by a combination of destruction of the IMF, ultrasound-assisted lipoplasty (UAL) of the chest wall, ultrasound stimulation of the breast skin, and periareolar deepithelialization, depending on the gyneocomastia classification. This classification and the treatment protocol were applied to 30 patients, 13 to 60 years of age, between January 2005 and December 2007. Among these patients, 12 were classified as type 1, 6 as type 2, and 12 as type 3. Follow-up ranged from 3 to 18 months. Complications were common to all types of cases and techniques. They included 2 hematomas, 1 wound dehiscence, 5 cases of residual gynecomastia in those patients who underwent UAL alone, and 3 minor aesthetic problems near areolae. The proposed new classification and treatment protocol were found to help solve problems associated with surgical outcomes for all types of gynecomastia, although the issue of residual gynecomastia in patients undergoing UAL alone requires further study.