Comparative Study between Reconstruction of Grade III Gynecomastia in Single Stage versus Two Stage Reconstruction

Abstract

Background: The difficulty of treating severe grades ofgynecomastia lies in the resection of excess skin. This resectioncan result in extensive scars located in conspicuous sites. Toreach the optimum results, excess skin should be excised andthe excess fat and gland should be managed too. Managingthe excess fat, enlarged mammary gland, together with excisionof excess periareolar skin with nipple-areola transposition insingle-stage is associated with higher risk of injuring thevascular pedicle of nipple-areola, and also associated withexcessive pleating of periareolar skin due to the suddenreduction in the size of areola which don't allow for skinretraction to occur. Staged-reconstruction will allow for gradualreduction in the size of areola allowing for skin adaptationleading to minimal pleating of periareolar skin, and alsopreserve the nipple-areola vascularity.Aim of Work: Is to compare between reconstruction ofgrade III gynecomastia in single-stage versus two-stage, asregard the complications rate.Patients and Methods: Twelve patients with severe (gradeIII) gynecomastia with enlarged ptotic nipple-areola, underwentsurgery over a 2-year period. All patients were marked preoperatively.Under general-anesthesia, traditional liposuctionof the pei-glandular area was performed, followed by deepithelializationof excess peri-areolar skin to elevate thenipple-areola. The glandular tissue was delivered by “pullthrough”technique, through a lateral trans-dermal peri-areolarincision. Study performed on two groups, group I, surgerywas performed in single-stage, while in group II, surgery wasperformed in two-stages, with liposuction of excess fat andresection of excess peri-areolar skin with elevation of nippleareolain the first stage then, three months later, patientsunderwent minimal liposuction just to facilitate delivery ofthe gland, with its delivery using the “pull-through” technique.Results: Fellow-up period was 6 months. No hematoma,seroma, breast skin necrosis, breast asymmetry, or nippleareolamalposition were detected post-operative in both groups.Results were reported as “uniformly good to excellent” on apatient satisfaction scale, as all patients were satisfied withtheir breasts contour and nipple-areola position postoperative.Transient hyposthesia of nipple-areola occurred and improvedspontaneously at 6 months post-operative. By comparing thecomplications rate between both groups, results showed thatsingle-stage reconstruction in group I was associated withhigher complications rate as regard the nipple-areola vascularity,and as regard the presence of excessive pleating of69periareolar skin than in group II. One case in group I showcomplete loss of nipple-areola. Another case of nipple-areolavascular compromise and partial necrosis were also detectedin group I. While, no cases showed compromised vascularityof nipple-areola in group II patients with two-stage reconstruction.Conclusions: Two-stage reconstruction is considered assafe procedure for correction of severe (grade III) gynecomastia,which preserve nipple-areola vascularity, and permitsbroad resection of excess skin and mammary tissue, whileavoiding unattractive scars on the patient's chest, with minimalpleating of periareolar skin.