Liposuction Assisted De-Epithelialization Pull-Through Technique for Management of Grade IIB and III Gynecomastia

Background: Gynecomastia is an abnormal and benignenlargement of male breast tissue. It occurs as a result of animbalance between estrogen and androgen levels that may bedue to a physiological or pathological cause. Multiple surgicalapproaches have been recommended to manage this problem.It is widely accepted that liposuction solely or when combinedwith subcutaneous mastectomy is effective for the managementof low to intermediate grades of gynecomastia. However,liposuction along with subcutaneous mastectomy gives unsatisfactoryresults in high grades where there is excess redundantskin that needs excision. Several skin incisions have been mentionedin literature for excision of excess skin, however, someof these are accompanied by unaesthetic scars.Objective: To assess the outcome of surgical correction ofhigh grades of gynecomastia in a single-stage procedure.Patients and Methods: We conducted a prospective analysison 20 patients with grades IIb or III gynecomastia who underwentsingle-stage procedures. Photographs were clinicallyevaluated by two independent surgeons with respect to chestcontour, symmetry, scar, and residual ptosis. Patient satisfactionwas surveyed regarding chest contour and scar appearance.Results: Statistical analysis revealed a significant improvementin patient's clinical measurements after operation,good doctor's scoring and patient satisfaction scoring amongstudied cases, and accepted complication rates.Conclusions: The current approach eliminates the need forskin resection in a second surgery, permits immediate skin recontouring,and achieves an acceptable aesthetic scar.