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The Surgical Management of High-Grade Gynecomastia

Tashkandi, Mohammad MBBS; Al-Qattan, Mohammad M. FRCS; Hassanain, Jamal M. FRCS; Hawary, Mohammad B. FRCSC; Sultan, Mahmoud MD

doi: 10.1097/
Original Article

It is now well accepted that low grades of gynecomastia are best treated with liposuction alone. However, the surgical management of the high-grade gynecomastia (Simon’s grade III) has remained problematic because both liposuction and conventional subcutaneous mastectomy (without skin excision) have frequently resulted in significant residual skin redundancy, requiring a second operation for skin resection. Our preferred approach to high-grade gynecomastia has been the single-stage subcutaneous mastectomy and circumareolar concentric skin reduction with deepithelialization. However, in the rare case of tubular breast deformity in the male and also in patients with gynecomastia who underwent massive weight loss, simple mastectomy and free nipple graft is performed. Therefore, these 2 groups of patients will be excluded from the current series. Twenty-four consecutive males with high-grade gynecomastia were reviewed. All patients underwent subcutaneous mastectomy with concentric skin resection. There were no major complications such as infection, hematoma, seroma, or nipple-areola complex necrosis. The main disadvantage of the technique was the mild residual skin redundancy, which was noted in all 24 patients. This redundancy, however, was never severe enough to require a secondary procedure, and all patients were satisfied with the final result.

Twenty-four consecutive high-grade gynecomastia patients were treated with subcutaneous mastectomy with concentric skin resection. Mild skin redundancy was present in all patients but not severe enough to merit a secondary procedure.

From the Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia

Received August 1, 2003 and accepted for publication, after revision, October 31, 2003.

Reprints: Prof. M. M. Al-Qattan, FRCSC, P.O. Box 18097, Riyadh 11415, Saudi Arabia. E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.