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

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.