Modern Solutions to Traditional Problems and Complications of Gynecomastia

The problems following correction of gynecomastia relate to poor healing or treatment that is inadequate or unsatisfactory. Unfavorable healing includes hematoma, seroma, wound separation, or skin loss. Unsatisfactory treatment ranges from incomplete or excessive resection, residual skin laxity to disturbing scars. Proper approach and careful technique are needed. My current approach for gynecomastia contains six options: (1) transareolar excision of offending breast tissue, (2) VASERlipo, (3) radiofrequency tightening, (4) liposculpture of the chest with lipoaugmentation of the pectoralis muscle, (5) a variety of skin excision patterns, and (6) combination therapy. The therapeutic options are arrayed across the modified Simon classification. The aesthetic goal is subtotal glandular reduction, with proper position and shape of the nipples, no inframammary folds, a masculine appearance, and adherent chest skin that reflects the musculoskeleton. The presence of extensive scars detracts. In mild cases, minimal scarring can be achieved by transareolar direct resection or by a wide area of liposuction, depending on spontaneous retraction of the skin envelope. Ultrasonic-assisted lipoplasty is more effective than traditional liposuction for the removal of dense glandular and fibroconnective tissues. Nevertheless, pull-through resection of the fibrous gland is often required. Residual mild to moderate skin laxity should be amenable to subcutaneous bipolar radiofrequency-assisted lipolysis. Over the past 2 years, this author has been reducing skin laxity by the application of BodyTite®. Lipoaugmentation of the pectoralis muscle not only improves masculinity but also reduces tissue laxity. Innovative boomerang pattern for large skin resections for Grade IIIb has been both effective and aesthetic. Clinical cases will demonstrate these multiple approaches and their pitfalls.