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Surgical Management of Gynecomastia: An Outcome Analysis

Kasielska, Anna MD; Antoszewski, Bogusław MD, PhD

doi: 10.1097/SAP.0b013e31824e296a
Breast Surgery

Background The aim of the study was to evaluate the surgical management of gynecomastia focusing on techniques, complications, and aesthetic results. The authors also proposed an evaluation scale of the cosmetic results after the treatment.

Methods We conducted a retrospective analysis of 113 patients undergoing the surgery for gynecomastia in our department. Preoperative clinical evaluation included the grade of gynecomastia, its etiology, and side, whereas postoperative analysis concerned histologic findings, complications, and cosmetic results.

Results Operative techniques included subcutaneous mastectomy through circumareolar approach in 94 patients, subcutaneous mastectomy with skin excision in 9 patients, inverted-T reduction mastopexy with nipple-areola complex (NAC) transposition in 6 subjects, and breast amputation through inframammary fold approach with free transplantation of NAC in 4 cases. Complications occurred in a total of 25 patients and did not differ statistically within Simon stages.

Conclusions The operative technique appeared to be the crucial determinant of good aesthetic outcome. The postoperative result of shape and symmetry of the NAC was not as satisfactory as postoperative breast size and symmetry. We showed that subcutaneous mastectomy using a circumareolar incision without additional liposuction provides a good or very good aesthetic outcome in patients with Simon grades I to IIa gynecomastia and that it is challenging to achieve a very good or even a good aesthetic outcome in patients with Simon grades IIb to III gynecomastia.

From the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Lodz, Poland.

Received October 18, 2011, and accepted for publication, after revision, January 30, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Anna Kasielska, MD, Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital No 1, Kopcinskiego 22, 90-153 Lodz, Poland. E-mail:

© 2013 by Lippincott Williams & Wilkins