Surgical Management of High Grade Gynecomastia: Combination of Liposuction, Glandular Resection and a Circumareolar Skin Reduction

Abstract

Background: Gynecomastia is defined as an excessivelydeveloped male breast to the extent it resembles the femaleone. Emotional discomfort and social embracement motivatethe patients to seek a medical advice, to restore the masculinebreast shape. In high grade gynecomastia, the contributingfactors are excess redundant skin, fibro-glandular tissue andabundant adiposity, each component should be consideredseparately in the patient's surgical plan. Various surgicalprocedures were succeeded to correct this deformity but withdrawbacks such as residual unsightly scar, or contour irregularities.Objectives: Were to treat high grades of gynecomastiawith a multifaceted procedure; by combining liposuction,glandular excision together with excess skin resection throughcircumareolar concentric approach.Aim: This study has evaluated that procedure as regardtechnical refinements, early and late complications and aestheticoutcome.Method: In this case series, eighteen healthy male patientswho had bilateral gynecomastia, had undergone correction oftheir breast deformity with that multifaceted procedure betweenJanuary 2016 and June 2017, their ages ranged from [17-61years old, with mean ± 30.94].Results: All patients were satisfied with the results exceptone patient who had undergone reoperation. The early complicationrate was 27.7%; it was consistent with other series.The follow-up aesthetic evaluation scale showed that 65% ofpatients with very good result, 22% of patients with goodresult, 17% patients with average result, and only one patienthad poor result.Conclusion: This combination had succeeded to addressthe contributing causes of severe gynecomastia. The problemsof excess and displaced tissues were properly dealt withthrough circumareolar approach to achieve a pleasant scarconfined to the areola with flat male chest