Surgical treatment of gynecomastia and pseudo-gynecomastia

Abstract

The aim — to evaluate and analyze the surgical treatment results of patients with varying degrees of gynecomastia and pseudo‑gynecomastia. Materials and methods. 62 patients were under our supervision: with gynecomastia — 29, with pseudo‑gynecomastia after significant weight loss — 22 and with fatty hypertrophy of breast — 11. All patients underwent clinical studies (determining the size of the breast and the degree of its ptosis, the excess volume of skin‑fat folds to be removed, as well as the parameters of the nipple areola complex (NAC) and the distance to which it was necessary to move it). Ultrasound examination and MRI were obligatory studies for neoplasms excluding and fat‑gland tissue ratio definition. According to clinical studies, all patients were divided into four groups. Group I included 15 patients with true gynecomastia I — II st. Group II comprised 11 patients with fatty hypertrophy of the breast and a slight excess of skin. Group III included 14 patients with gynecomastia III — IV st. with an increase in the volume of glandular and adipose tissue, ptosis of the breast and excess skin. Group IV consisted of 22 patients after a massive weight loss of II — III st. In patients group I a direct excision of stromal‑glandular tissue with the use of periareolar incision with sparing liposuction was found. In the patients group II thymine‑based liposuction without excision of excess tissues was performed. Patients of group III initially developed an enlarged lipofibrospiration, following an ellipsoidal resection of the excess tissue. All operations were carried out simultaneously. In 5 cases, with expressed ptosis and excess breast tissue, a technique was used with the formation of the upper feeding NAC «legs» and the removal of excess tissues. Patients of group IV underwent resection of excess tissues with the movement of NAC on the feeding «leg» or with its free transplantation. After labeling, lipofibrospiration was performed. In 6 patients with pronounced skin‑fat folds on the lateral surface of the thorax, the operation was used in our modification. This allowed to improve the contour of the chest and reduce the risk of prolonged lymphorrhea characteristic of this zone. In 3 patients with III st. pseudogynecomastia after extensive resection of excess tissues, it was decided to perform a free NAC transplant. Corrective operations were performed 6 — 9 months after the initial surgical intervention. Results and discussion. All operated patients remained under observation for 6 months up to 12 years. Control examinations were carried out on 3, 6, 9 and 12 months after surgical treatment. The immediate and long‑term results were evaluated separately in all clinical groups. Long‑term postoperative results were evaluated with respect to the main criteria: breast and NAC shape, quantity and quality of postoperative scars, presence or absence of relapse. Good and satisfactory results were obtained in 14 of 15 patients of group I; in 9 out of 11 patients in group II, in 10 of 14 patients in group III, and in 15 of 22 patients in group IV. Corrective operations were performed in 17 patients from group ІІІ and IV to improve the esthetic result. Conclusions. The variety of gynecomastia and pseudo‑gynecomastia variants especially in the case of massive weight loss, require the surgeon to apply all the methods of aesthetic mammoplasty. Only a differentiated approach to the choice of the optimal surgical method allows to achieve the maximum result of the operation, eliminate the psycho‑emotional complexes in the patient and improve the quality of life.