Gynaecomastia Surgery Research Articles

Comparison of Serratus Anterior Plane Block by Anatomical Landmark-Guided Technique Versus Ultrasound-guided Technique for Gynaecomastia Surgery: A Randomized Controlled Trial

Background: Breast surgeries are common surgical procedures and postoperative pain after mastectomy is a major concern as inadequate pain relief can result in chronic pain and reduced quality of life. Serratus anterior plane (SAP) block is suitable for perioperative analgesia for gynaecomastia correction surgery. Objectives: To compare postoperative pain relief using the VAS and D-VAS scores between anatomical landmark-guided SAP block and ultrasound-guided SAP block in patients undergoing surgery for gynecomastia correction. Methods: Patients aged 16-40 years, belonging to American Society of Anaesthesiologists (ASA) physical status I or II who were scheduled for gynaecomastia correction surgery were randomized and allocated into two groups. Group I (n = 15) patients received 20 ml of 0.25 % bupivacaine solution with 20 μg of Fentanyl by anatomical landmark-guided SAP technique while Group II (n = 15) patients in the control group received same drug using ultrasound-guidance technique. VAS and D-VAS from arrival to post anaesthesia care unit (PACU), then after 30 minutes, and at 1 hour, 2 hours, 6 hours, 12 hours, 18 hours, and 24 hours. Results: Both groups had comparable results in terms of pain scores at different time intervals, duration of analgesia (615 mins vs 706 mins) and need for rescue analgesics. Conclusion: Anatomical landmark-based SAP block technique is comparable to the ultrasound-guided SAP block technique in terms of efficacy and duration of analgesia with lesser complications. The former can serve as an alternative to the latter technique in resource-limited countries.

Should the ‘normal’ and ‘ideal’ nipple position in a male influence the surgeon when planning severe gynaecomastia correction?

BackgroundThe ideal nipple areolar complex (NAC) position of the male chest following gynaecomastia surgery is well documented; however, with increased development of the chest muscles, the NAC placement can change, leading to the medial displacement of the nipple giving a poor aesthetic outcome. Therefore, we believe that these measurements need to be applied to the patients’ build and take into consideration the future fitness goals of the patients. MethodWe have analysed the photographs of three groups of men: super athletes, athletes and individuals with severe gynaecomastia. We have assessed the proportions of the chest in relation to the NAC, degree of ptosis and TAP index. ResultsThere was a wide variation between the athlete and the super athlete group, with minor variations within each group. The range of measurement in the severe gynaecomastia group was significantly larger than those in the other groups. We feel that based on this research study, surgeons should however be somewhat circumspect in their choice of nipple position as there is a wide variation in what can be considered as normal, and positioning of the NAC too early in the recovery process may lead to an abnormal aesthetic appearance following muscle development. ConclusionDespite the multitude of techniques available in the literature to determine the position of nipple, there is a lack of understanding on how the NAC position changes with muscle development. Adopting a dogmatic approach may result in a very aesthetically displeasing outcome, which can be very difficult to correct in men.

External Quilting: New Technique to Avoid Haematoma in Gynaecomastia Surgery.

Haematoma after gynaecomastia surgery is the most common early complication. It may necessitate a return to the theatre and cause increased infection risk, poor wound or delayed healing, and abnormal scar. Strategies to avoid haematoma range from perioperative blood pressure control to the use of tranexamic acid and compressive dressings. To demonstrate a new technique that would avoid haematoma or limit its expansion should it occur, after gynaecomastia surgery. One hundred and forty-nine patients had surgery for gynaecomastia between 2018 and 2019 by the senior author. External quilting sutures are used to obliterate any dead space following liposuction and piecemeal excision to address fatty, stromal, and glandular components. No drains are used. Patients receive cooling therapy before discharge, and they reattend clinic the following day for suture removal. Two patients had haematomas which were managed conservatively and healed well. Fine suture tracks, which were observed in another two patients, became unnoticeable at 3months. Overall, the complication rate in our cohort was 2.7% (haematoma 1.3%, temporary suture track 1.3%). Our method is useful in minimising haematoma. It limits expansion of haematoma should it occur. Suture track is the other transient complication. This new technique in gynaecomastia correction is simple, yields good results, and gives the surgeon another option to deal with haematoma. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The “postcode lottery” for the surgical correction of gynaecomastia in NHS England

IntroductionAction On Plastic Surgery (AOPS) criteria for funding of gynaecomastia surgery are: the patient should be post-pubertal, have a BMI ≤ 25 kg/m2, endocrine and drug causes and breast cancer should be excluded and the patient should demonstrate psychological distress. We evaluated how NHS funding for gynaecomastia surgery varies between Clinical Commissioning Groups (CCGs) in England and whether there is a “postcode lottery”. MethodsThe gynaecomastia surgery policies for 211 CCGs in NHS England were reviewed against the AOPS criteria and grouped according to their funding policies: group 1 (if criteria met, funding approved); group 2, (if criteria met, prior approval required); group 3 (no criteria, individual funding request only) and group 4 (no funding). ResultsPolicies were available for all CCGs. Fifty-nine (28.0%) CCGs were in group 1, 87 (41.2%) in group 2, 44 (20.9%) in group 3 and 21 (10.0%) in group 4. Of those in groups 1 and 2, five (3.4%) CCGs used all six AOPS criteria. Approximately 70% CCGs with criteria (in groups 1 and 2) stipulated that the patient should be post-pubertal, have a BMI ≤ 25 kg/m2 and endocrine and drug causes should be excluded. Breast cancer should be excluded in 51.4% and the patient should show psychological distress in 13.7% CCGs. Of those in groups 1 and 2, 118 (80.8%) CCGs specified additional criteria. ConclusionsCCGs do not use the AOPS criteria uniformly and restrict surgery according to their own criteria. Overall, there is a “postcode lottery” for gynaecomastia surgery within NHS England.

A novel method of marking nipple areola complex in gynaecomastia surgery.

A novel method of marking nipple areola complex in gynaecomastia surgery.

The “postcode lottery” for the surgical correction of gynaecomastia in NHS England

Abstract Introduction Action On Plastic Surgery (AOPS) criteria for funding of gynaecomastia surgery are: the patient should be post-pubertal, have a BMI ≤ 25 kg/m 2 , endocrine and drug causes and breast cancer should be excluded and the patient should demonstrate psychological distress. We evaluated how NHS funding for gynaecomastia surgery varies between Clinical Commissioning Groups (CCGs) in England and whether there is a postcode lottery. Methods The gynaecomastia surgery policies for 211 CCGs in NHS England were reviewed against the AOPS criteria and grouped according to their funding policies: group 1 (if criteria met, funding approved); group 2, (if criteria met, prior approval required); group 3 (no criteria, individual funding request only) and group 4 (no funding). Results Policies were available for all CCGs. Fifty-nine (28.0%) CCGs were in group 1, 87 (41.2%) in group 2, 44 (20.9%) in group 3 and 21 (10.0%) in group 4. Of those in groups 1 and 2, five (3.4%) CCGs used all six AOPS criteria. Approximately 70% CCGs with criteria (in groups 1 and 2) stipulated that the patient should be post-pubertal, have a BMI ≤ 25 kg/m 2 and endocrine and drug causes should be excluded. Breast cancer should be excluded in 51.4% and the patient should show psychological distress in 13.7% CCGs. Of those in groups 1 and 2, 118 (80.8%) CCGs specified additional criteria. Conclusions CCGs do not use the AOPS criteria uniformly and restrict surgery according to their own criteria. Overall, there is a postcode lottery for gynaecomastia surgery within NHS England.

Conventional versus ultrasound-assisted liposuction in gynaecomastia surgery: A 13-year review

Numerous surgical techniques exist for gynaecomastia treatment. Although ultrasound-assisted liposuction (UAL) is thought to be more effective than conventional liposuction, to date there remains no objective and direct comparison of the two modalities. Hence, a comparative study was performed of a single surgeon's experience over 13 years using two definitive parameters, namely intraoperative conversion to open excision and postoperative revisional surgery rates. All gynaecomastia patients treated with UAL or conventional liposuction (1999-2012) were retrospectively studied. UAL was only available in the private sector and was used for all such patients with no other selection or exclusion criteria. A total of 219 patients (384 breasts) with a mean age of 29 years (range 12-74) were evaluated. UAL was utilised in 24% of breasts (47 patients, 91 breasts). Compared with conventional liposuction, UAL had significantly lower rates of intraoperative conversion to open excision (25% vs. 39%; p<0.05) and postoperative revision (2% vs. 19%; p<0.001) using Fisher's exact test. The haematoma rate for each technique was 1%. UAL is a more effective treatment modality for gynaecomastia than conventional liposuction as determined by intraoperative conversion to open surgery and subsequent need for revision.

Gynaecomastia surgery in The Netherlands: What, why, who, where…

Gynaecomastia, breast enlargement in men, is common in all age groups. It is operated on by plastic surgeons, general surgeons and paediatric surgeons. It is therefore possible that there is a difference in the populations treated, the indications for surgery and the management used by the different practitioners. We performed a survey in order to assess the approach to treatment of gynaecomastia by the different disciplines. An electronic survey questionnaire was sent to members of the Dutch societies of surgery, paediatric surgery and plastic surgery. We received 105 responses from plastic surgeons, 95 from general surgeons and 15 from paediatric surgeons, representing respective response rates of 38.7%, 23.8% and 42.8%. Plastic surgeons operated on gynaecomastia most frequently. The diagnostic criteria and workup were similar for all disciplines, although general surgeons used more imaging. There was a difference in the side operated on. General surgeons and paediatric surgeons operated mainly on unilateral cases (74% and 52%), while plastic surgeons operated mainly on bilateral cases (85%). Pharmaceutical treatment with Tamoxifen was reported only by general surgeons (13%). All disciplines used mainly the periareolar incision. Plastic surgeons reported more often the use of other surgical approaches as well as adjunctive liposuction and they did not always submit tissue for pathological examination. Perioperative antibiotics, drains and pressure garments were not always used. All disciplines agreed that the most common complication was bleeding, followed by seroma, infection, insufficient results, inverted nipple and nipple necrosis. This survey highlights some differences in the practice of gynaecomastia surgery. The findings appear to point to the fact that the indications are different, being more aesthetic in the case of plastic surgeons. The results of this survey are important in establishing the standard of care and may be helpful for setting guidelines.

Trans-nipple removal of fibro-glandular tissue in gynaecomastia surgery without additional scars: An innovative approach.

Context:The established techniques that have been used to treat gynaecomastia are said to have relatively less patient satisfaction rate as they leave some visible scars or mild elevation over the nipple areola complex, resulting in aesthetically unsatisfactory results. Even the slightest elevation or smallest scar over nipple areola complex leave patients extremely self conscious and in a dilemma of having a second intervention to get rid of that blemish.Aims:The aim of the study is to achieve - A flat chest without adding a scar and with no chances of re-occurrence of the condition. This article suggests an innovative approach to address the problem.Materials and Methods:The author presents trans-nipple incision approach for the delivery of fibro-glandular tissue component following liposuction for maximum patient satisfaction. This method consists of a unique small criss-cross incision right on the nipple itself for retrieving any volume of tough fibro-glandular tissues. Between the duration of January 2012 to October 2013, 28 male patients of different ages were operated with this technique.Results:The surgery resulted in well-shaped, symmetric chest contour without any visible elevation or additional scars on nipple areola complex. No complications were noticed in any of the patients.Conclusions:The presented technique is proved to have a high patient satisfaction rate and to be promising method to achieve good aesthetic results in gynaecomastia surgery.

Surgical management of Gynaecomastia: Outcomes from our experience

The study aims to assess the morbidity and outcomes associated with gynaecomastia surgery. Between 1998 and 2007, 748 males with a mean age 44.67 years (10–90) were referred to us with breast-related symptoms. From these only 65 patients (102 breasts), with a median age of 26 years (11–82) had an operation for gynaecomastia. We considered for the purpose of the study each operated breast as an individual case. Overall, 42 cases of grade I gynaecomastia, 40 with grade II and 20 with grade III were treated mainly with subcutaneous mastectomies, 22 with skin reduction. Acute major complications requiring intervention occurred in 12 cases. Twenty-three cases required a late corrective operation for unsatisfactory results. The surgical approach appears to be the most important determinant of good cosmesis with the circumareolar approach to give the better results. The majority of the patients can be managed conservatively. Surgical candidates should be made aware of the significant morbidity.