TRENDS IN GYNECOMASTIA
Gynecomastia is referred to as male breast reduction. It is associated with glandular tissue and fatty tissue found in the entire chest area. This extends from the infraclavicular, under the clavicle, along the parasternal to the inframammary fold and all the way laterally to the anterior axillary line. There are two different types of tissue that can be found in gynecomastia patients. They include glandular tissue and fibrofatty tissue. The fatty tissue can usually be sculpted around the chest area, while the gynecomastic tissue normally requires direct excision through a periareolar approach.
Our patients are normally placed under general anesthesia and an incision is made underneath the nipple areolar complex from approximately the 5:00 to 7:00 o’clock position. At this time infiltration of tumescent fluid with a Klein needle is performed and liposuctioning with a 3 mm triple lumen Mercedes cannula to 1 atmosphere of vacuum suction pressure is used to sculpt the chest area, again extending along the sternum to the infraclavicular at the anterior axillary line and down to the inframammary fold. A large wedge of tissue is then removed, usually it’s a wafer of tissue in the shape of a football, from the posterior retroareolar region. A platform of glandular tissue is however maintained with the undersurface of the nipple areolar complex to contour and depression deformities.
After removing this large wedge of tissue, it is taken down to the fascia overlying the pectoralis major muscle. Hemostasis is acquired using electrocautery. Deep closure is performed to close the dead space, 2-0 Vicryl sutures and the simple subdermal and simple subcuticular sutures to close the skin.