Integrating the Fast-Track surgery concept into the surgical treatment of gynecomastia

Abstract

Background: The use of fast-track surgery pathway has been reported to reduce the stress of operation and accelerate rehabilitation in various surgical specialties. However, there has been a relative dearth of research on this subject for surgical treatment of gynecomastia. Materials and methods: The gynecomastia was treated by liposuction plus pull-through technique. The safety and recovery profiles were retrospectively compared between the patients in a standard pathway (including general anesthesia and postoperative drainage) and those in a fast-track pathway (including patient education, local tumescent anesthesia, no drainage, and effective pain control). Registered outcomes included postoperative complications, time to normal life, length of stay, patient satisfaction, etc. Results: From October of 2017 to October of 2021, 126 gynecomastia patients with Simon’s grade I or II who underwent the surgical treatments were included in the study, of which 25 patients were treated according to standard pathway, and 101 patients underwent the fast-track pathway. During the follow-up, there was no difference between the cohorts in the incidence of postoperative complications. Both the time to normal life and length of stay significantly decreased to 0 after the introduction of fast-track pathway. Overall, 94.1% of the patients ranked the fast-track surgical pathway as ‘great’ or ‘moderate' at the 3-month follow-up. Conclusions: The proposed fast-track pathway is feasible for surgical treatment of gynecomastia, leading to an enhanced recovery and high patient satisfaction without increasing the rate of complications. The fast-track surgery concept with implementation of local anesthetic techniques should be given serious consideration in gynecomastia management.