DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175467

Gynecomastia our surgical experience using liposuction and minimal invasive surgical excision and its psychological benefits to young patients

Dhananjay Vinayak Nakade, Manish Zade, Jitendra Mehta, Pawan Shahane, Shitij Gupta

Abstract


Background: Gynecomastia is a benign enlargement of the male breast usually bilateral sometimes unilateral resulting from proliferation of glandular component of the breast. It is defined clinically by presence of rubbery or firm mass extending from nipple. The glandular tissue grows under influence of hormonal stimulation and is tender. Gynecomastia frequently presents social. Psychological, difficulties as low esteem and shame to sufferer. During adolescence many young males have gynecomastia and they are eager to do surgery of gynecomastia. Aims and objectives of the study was to correct deformity restoring normal contour to the chest, maintaining viability of nipple and areola. Also avoiding excess scarring and preventing saucer type deformity. To relieve emotional discomfort, psychological distress, and intolerable pain, to relieve shame in going to society, social gathering even doing marriage. To study effect of adding liposuction to surgical excision.

Methods: This is two-year study of 20 cases of gynecomastia. Clinical and Laboratory findings were normal. preoperatively patients are selected by their complaints, discomfort, psychological effects, shame, depression, anxiety and size of gynecomastia. In surgery, we have done is liposuction thoroughly after infiltration with adequate amount of ringer solution and Inj adrenaline 1:100000 concentration. In gynecomastia with group 1 and 2 we used websters incision, in group 2b we used extended websters incision if required. In very large gynecomastia with skin excess we have done breast reduction with liposuction and free nipple grafting in one case and medial pedicle based, superiorly based flap in two cases, two cases with circumareolar skin excision and liposuction in group 2 b case. In rest 16 cases we have done liposuction, excision through websters incision.

Results: In our study of 20 cases done in two years, in our department of plastic surgery at NKPSIMS, one was unilateral and rest 19 were bilateral gynecomastia cases. In all cases liposuction as treatment modality used and has given satisfactory outcome in 18 (90%) cases out of 20, 3 (10%) cases want more liposuction and if possible re excision. Average hospital stay was 2 days. Post-operative recovery was good in majority cases but in 2 ((10%) cases post op numbness and ischemia at margin of areola occurred treated conservatively. In one case (5%). dehiscence of wound healed Conservatively. All cases of breast reduction were healed well. All cases benefited psychologically by surgery and their self-image in society improved lot.

Conclusions: The problem of excessive fat and fibroglandular tissue is managed by liposuction and excision through websters incision. In high grade gynecomastia of grade 3 we have done breast reduction. This has corrected deformity, restoring normal contour to majority of patients and they improved psychologically, and their self-image improved and so their social life.


Keywords


Gynecomastia, Liposuction depression and anxiety, Male breast, Psychological benefit, Reduction, Surgical reduction

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References


Nydick M, Bustos J, Dale JH, Rawson RW. Gynecomastia in adolescent boys. Jama. 1961;178(5):449-54.

NUTTALL FQ. Gynecomastia as a physical finding in normal men. J Clinic Endocrinol Metabol. 1979;48(2):338-40.

Wassersug RJ, Oliffe JL. The social context for psychological distress from iatrogenic gynecomastia with suggestions for its management. J Sexual Medic. 2009;6(4):989-1000.

Kasielska A, Antoszewski B. Effect of operative treatment on psychosocial problems of men with gynaecomastia. Polish J Surg. 2011;83(11):614-21.

Fruhstorfer BH, Malata CM. A systematic approach to the surgical treatment of gynaecomastia. Brit J Plastic Surg. 2003;56(3):237-46.

Sarkar A, Bain J, Bhattacharya D, Sawarappa R, Munian K, Dutta G, Naiyer GJ, Ahmad S. Role of combined circumareolar skin excision and liposuction in management of high grade gynaecomastia. J Cutaneous Aesthetic Surg. 2014;7(2):112.

Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plastic and reconstructive surgery. 1973;51(1):48-52.

Pittman GH. Breast and chest wall. In Pitman, G H Ed. Liposuction and Aesthetic surgery, Quality Medical Publishing, Inc. St. Louis. 1993;197- 215.

Boljanovic S, Axelsson CK, Elberg JJ. Surgical treatment of gynecomastia: liposuction combined with subcutaneous mastectomy. Scandinavian J Surg. 2003;92(2):160-2.

Abramo AC. Axillary approach for gynecomastia liposuction. Aesthetic plast Surg. 1994;18(3):265-8.

Webster DJ. The male breast. Br J Clin Pract. 1989;68:137.

Noer HH, Søe-Nielsen NH, Gottlieb J, Partoft S. Gynecomastia treated by subcutaneous mastectomy using Webster's method. Ugeskrift for laeger. 1991;153(8):578-80.

Pitanguy I. Transareolar incision for augmentation mammaplasty. Aesthetic plastic Surg. 1978;2(1):363-72.

Davidson BA. Concentric circle operation for massive gynecomastia to excise the redundant skin. Plastic Reconstructive Surg. 1979;63(3):350-4.

Persichetti P, Berloco M, Casadei RM, Marangi GF, Di Lella F, Nobili AM. Gynecomastia and the complete circumareolar approach in the surgical management of skin redundancy. Plastic Reconstructive Surg. 2001;107(4):948-54.

Huang TT, Hidalgo JE, Lewis SR. A circumareolar approach in surgical management of gynecomastia. Plastic Reconstructive Surg. 1982;69(1):35-40.

Persichetti P, Berloco M, Casadei RM, Marangi GF, Di Lella F, Nobili AM. Gynecomastia and the complete circumareolar approach in the surgical management of skin redundancy. Plastic Reconstructive Surg. 2001;107(4):948-54.

EL-NAGAR AE. Circumareolar Inferior Pedicle Mammaplasty for Treatment of Gynecomastia with Breast Ptosis. Medic J Cairo University. 2010;78(2).

Letterman G, Schurter M. Surgical correction of massive gynecomastia. Plastic Reconstructive Surg. 1972 ;49(3):259-62.

Losken A, Holtz DJ. Versatility of the superomedial pedicle in managing the massive weight loss breast: the rotation-advancement technique. Plastic Reconstructive Surg. 2007;120(4):1060-8.

Brown RH, Chang DK, Siy R, Friedman J. Trends in the surgical correction of gynecomastia. InSeminars in plastic Surg. 2015;29(2):122-130.

Pensler JM, Long JN. Plastic surgery for Gynecomastia Treatment and Management. Medscape. 2016.

Gurunluoglu R, Gurunluoglu AA. Paulus Aegineta, a seventh century encyclopedist and surgeon: his role in the history of plastic surgery. Plastic Reconstr Surg. 2001;108:w072-2079.

Boljanovic S, Axelsson CK, Elberg JJ. Surgical treatment of gynecomastia: liposuction combined with subcutaneous mastectomy. Scandinavian J Surg. 2003;92(2):160-2.

Abramo AC. Axillary approach for Gynecomastia liposuction. Aesthetic plastic surgery. 1994;18:265-268.

Rohrich RJ, Ha RY, Kenkel JM, Adams WP. Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plastic Reconstructive Surg. 2003;111(2):909-25.

Hammond DC, Arnold JF, Simon AM, Capraro PA. Combined use of ultrasonic liposuction with the pull-through technique for the treatment of gynecomastia. Plastic Reconstructive Surg. 2003;112(3):891-5.

Graf R, Auersvald A, Damasio RC, Rippel R, de Araujo LR, Bigarelli LH, Franck CL. Ultrasound-assisted liposuction: an analysis of 348 cases. Aesthetic plastic surgery. 2003;27(2):146-53.

Kipling M, Ralph JE, Callanan K. Psychological impact of male breast disorders: literature review and survey results. Breast Care. 2014;9(1):29-33.

Schonfeld WA. Gynecomastia in adolescence: effect on body image and personality adaptation. Psychosomatic Medic. 1962;24(4):379-89.