A systematic approach to the surgical treatment of gynaecomastia

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Abstract

Numerous techniques have been described for the correction of gynaecomastia, and the surgeon is faced with a wide range of excisional and liposuction procedures. There is a paucity of literature describing an integrated approach to the management of this condition and the roles of the different treatment modalities. A review of all gynaecomastia patients operated on by one surgeon over a 2-year period was undertaken. Patient satisfaction was assessed using a linear analogue scale with a maximum score of 10. In total, 48 breasts in 29 patients were treated—31 breasts by liposuction alone (19 by conventional liposuction, 12 by ultrasound-assisted liposuction), eight breasts by liposuction and open excision, and nine breasts by liposuction, open excision and skin reduction (concentric or Lejour mastopexy). There were no early postoperative complications, such as haematoma, seroma or infection, and 91% of patients were very satisfied (score: 8–10) with their cosmetic outcome. The most frequently encountered complication was a residual subareolar lump (five breasts), all in patients treated by conventional liposuction alone. In order to avoid the common complication of an uncomfortable residual subareolar nodule, the threshold for open excision in patients undergoing conventional liposuction should be low. Ultrasound-assisted liposuction extends the role of liposuction in gynaecomastia patients. Although skin excess remains a challenge, it can be satisfactorily managed without excessive scarring. A practical approach to the surgical management of gynaecomastia, which takes into account breast size, consistency, skin excess and skin quality, is proposed.

Section snippets

Patients and methods

All patients who were operated on for gynaecomastia by the senior author between September 1999 and November 2001 were included in the study. The grade of gynaecomastia was assessed from the patients' preoperative photographs and case notes. Following surgery, patients were reviewed in the outpatient clinic between September 2001 and January 2002. Patients who had already been discharged from follow-up were invited to attend the outpatient clinic for a further review. The patients were examined

Results

Overall, 29 patients underwent surgery for gynaecomastia over the 27 month period. Their ages ranged from 13 years to 57 years (mean: 25 years), and 19 patients presented with bilateral and 10 patients with unilateral gynaecomastia. In total, 48 breasts were surgically treated. The majority of the breasts treated were assessed as small to moderate (Table 1).

Nearly all the breasts were treated by liposuction, alone or as an adjunct (Table 2). One breast was treated by open excision alone,

Discussion

Surgery is the mainstay of treatment for gynaecomastia. Although a wide range of surgical techniques have been described, surgeons often find it difficult to choose the technique that will achieve the best results for a given patient.

In all patients, liposuction was planned as part of the procedure. The majority of breasts were treated by liposuction only. In 17 breasts, further correction by open excision and/or skin reduction was performed. Conventional liposuction combined with open excision

Acknowledgements

The authors thank Mrs Sue Ramsey, Medical Secretary, for kindly obtaining all the case notes and organising review appointments. Additional thanks to Mr. Phillip Ball, Senior Medical Artist, for the illustrations.

The Authors

Birgit H. Fruhstorfer FRCS, Clinical Fellow in Plastic Surgery

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    The Authors

    Birgit H. Fruhstorfer FRCS, Clinical Fellow in Plastic Surgery

    Charles M. Malata FRCS(Plast), Consultant Plastic Surgeon

    Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK

    Presented at the 37th Congress of the European Society for Surgical Research, Szeged, Hungary, 23–25 May 2002, and the Summer Scientific Meeting of British Association of Plastic Surgeons, London, UK, 3–5 July 2002.

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